The ambulance call came in shortly after 2 a.m. "We're bringing you a 27 y.o. unresponsive male with a head injury and alcohol on board." Despite the patient's unresponsive state, the prehospital team's vitals for this patient were stable.
We prepared a trauma room for this patient, unsure if we would need to intubate the patient to protect his airway and get an appropriate work-up. Alcohol ingestion with unresponsiveness can mean something very serious and, until we had a chance to thoroughly examine this patient, we would provide him with every cautionary medical measure available. Of course, flipping the coin, alcohol ingestion with unresponsiveness can also simply mean "passing out." And as anyone who has worked in an ER setting can tell you, the majority of patients who come in with these similar symptoms are usually just of the "passing out" variety.
Soon enough, the prehospital crew wheeled this patient through our ambulance bay doors and rushed him to Room 18, where we were waiting to greet them. The patient was disheveled, laying on his back, his head turned over his right shoulder. The smell of vomitus was overwhelming, a mixture of bile, soured alcohol, and undigested food. On closer inspection, that was not a designer graphic t-shirt he was wearing but rather a run-of-the-mill Hanes t-shirt sprinkled with the remnants of his puking. Corn kernals included. His cargo shorts were hanging halfway down his pelvis.
As we moved this patient from the transport cot to our hospital bed, the paramedics filled me in with a little history. "Einstein, here," the one paramedic started, "was out tonight with a bunch of buddies drinking and having a grand ol' time." He paused for a minute, chuckling to himself, before continuing. "Somewhere around his tenth drink, his buddies said he started head-butting anyone who would let him."
"You mean people actually let this guy come up to them and head-butt a 'hello' to them?" I asked, incredulous at the thought.
"They probably didn't see it coming," the paramedic answered. "Supposedly, he's real quick with the gesture," he continued, "like a head-butting champ or something."
How's that title for making your parents proud? "Champion Head-butter, 2010." I don't think I would have a prouder moment than if one of my children came home with that award. Especially if it came with some cash. Throw in a tiara and a sash, too.
"Anyway," the paramedic finished as we began hooking the patient up to our monitors, "he head-butted one too many people. He walked up to another drunk buddy of his, slammed heads with him, and literally dropped. Before he hit the floor, though, somebody standing next to him was able to catch him and ease him down. Witnesses said he was out like a light."
I yelled in this patient's ear and was happy to see him stir. I rubbed his chest and pinched his toes to make sure he was appropriately responsive, and he was, trying to swat away annoying me. I listened to this patient's heart and lungs. All clear. I reviewed his vitals. All stable. I looked closely at his pupils, happy to find them appropriately reactive. I was reassured that he was in no grave danger.
Now I had time to do a closer, more focused exam, starting with his head. Hardly surprising, this patient had a large, erythematous abrasion on his forehead, the skin tense from some localized swelling. I pushed on it to make sure his skull bones were stable underneath, expecting nothing less than a hard-head from this patient. He didn't disappoint. I looked in his ears and nose. No blood. I pushed on his facial bones and found no other abnormalities. The rest of his exam was also unremarkable.
In essence, this patient was a drunk with a big "goomba" on his forehead.
Prior to leaving his room and ordering his CT scans, the patient began stirring. His nurse, fresh out of nursing school, greeted him. "Hello, Mr. Sanders," she said, "I'm Chrissie and this here is Dr. Jim. We'll be taking care of you tonight." I said "hello" to him while I nodded my acknowledgement.
The patient must have liked what he saw in Nurse Chrissie, turning his attention back to her. In an artificially deep voice, slurred slightly, and with a lopsided grin, he said, "How you doin', Chrissie? You can call me Larry." He pulled his hands through his hair, trying to straighten-up a little. Unfortunate for him, though, there is a limit to how appealing you can make yourself when you are drunk, sitting in a hospital cot, covered in a gray, threadbare hospital gown. Oh, with a big "goomba" on your forehead.
"I'm good, Larry," Chrissie answered, enunciating 'Larry', "and how are you doing?" "I got a massive headache," he answered her. Then, turning to look at me, he said, "Hey dude, how about some medicine for this headache. Jesus H. Christ, already." I felt like head-butting him. In a nice, friendly way, of course.
A few minutes later, after this patient returned from the CT scanner and was waiting for his results, a call came back from the waiting room concierge. "Is it okay if Mr. Sanders has a few friends come back and wait with him?" "Are they sober or drunk?" the secretary rightfully asked before giving her permission. "They might have had a few drinks," the concierge said, "but they are really respectful and concerned."
I was walking down the hall, coming back from seeing another patient, when I saw Larry's friends coming from the opposite way. I wasn't aware of the concierge call, but none of that mattered. I knew who these two guys were the minute I saw them. I slowed my walking pace, wishing that the fluorescent hallway lights were just a little more brighter so I could better appreciate their appearances.
Both of the guys were wearing fashionable jeans with flip-flops that clucked with every step, graphic-Ts, and, barring the sprinkles of vomit that covered both of their fronts, looked quite hip. But these weren't the signs of their brotherhood, of best buddies out on a late Friday night having a great time, now bonding in our ER.
No, that sign would be the matching "goombas" they both wore on their foreheads. Bright pink, two inches in diameter, and glaringly obvious under their shaved heads, their warwounds looked almost identical to the injury of our patient, Larry. Their friend.
I stopped them as they walked by. "Hey guys," I said, having a little fun, "what happened to your heads?" The one remained silent, intently watching his pacing feet, while the other spoke. "You don't even want to know," he said, shaking his head in disappointment. "Well," I said, "if you guys want to be seen or get a bad headache, let us know, okay?"
Soon after, Larry's CT reports came back negative for any injury. Outside of a bad headache and a nice-sized contusion/abrasion, he was getting off quite nicely. I went to the room to explain his results to him, and caught my breath as I walked into Room 18. With these three buddies sitting close together with their matching injuries, how could I not think of The Three Muskateers?
Larry, thankful for not having any significant injuries, started crying (the gut-wrenching bawling brought on by a stiff drink) and throwing around his apologies to anyone who would accept one. A tech walking by his room even got one. "I'm so sorry, buddy," Larry said. "For what?" the tech asked. "I just am," he replied. The tech kindly went and got Larry a box of tissues.
Finally, a sober friend came to drive them home. A female. Long brown hair, very sophisticated-appearing, wearing a warm smile. Evidently, she also had a great sense of humor. She exhibited a hearty, genuine, gutteral laugh, I'm told, when she walked into Room 18 to gather her friends. And had a hard time stopping.
At least the patient was a gentleman. She wasn't sporting a matching forehead "goomba"...
As always, big thanks for reading. Trying to keep things light this week. See you Friday...
Showing posts with label alcohol. Show all posts
Showing posts with label alcohol. Show all posts
Wednesday, July 28, 2010
Friday, July 2, 2010
The Damaged Eyes of Alcoholism
I walked into the dimly lit treatment room, Room 31, to find my next patient quietly and calmly lying in her cot. She had curly graying hair which, when added with the deeply creased wrinkles of her face, made her look much older than her stated age. Despite her attempts to welcome me with a warm smile, her greeting seemed forced. Her smile was but a thready, thin blanket failing to cover the the cold of her pain.
The pain of an alcoholic.
Standing in the corner, huddled together as a unified front, stood two teenagers. A boy and girl. Unlike their mother, they made no attempt to cover their worry. Their appearances were youthful--Converse Chuck Taylor sneakers, straight-legged jeans, graphic t-shirts, and hip stylish haircuts. But their eyes, those pained and aching eyes, bore an unfortunate truth to the years of sadness they had endured. Of their lost innocence.
I introduced myself to the patient before focusing my attention a little more closely on her children. Despite their worry, they were gracious in returning my hellos, introducing themselves.
I turned back to the patient. "Ms. Smith," I asked, "what happened that brought you to our ER this evening?"
Ms. Smith looked at me blankly, a confused haze slowly overtaking her face. I spoke again. "Do you know why you are here this evening?" She continued to stare at me, worrying me with her silence, before eventually nodding her head "no." She spoke. "I have no idea what happened."
I turned to her children. "Can either of you tell me what happened with your mother?"
The son stared down at his feet in response to my question. The daughter, however, connected with my eye contact and spoke up as she nervously tucked her wispy, blondish curls behind her ears. "I think she had a seizure." She got quiet then, her eyes getting more glassy as we continued to hold one another's gaze.
"Please, go on," I encouraged her and she bravely continued her story. She and her brother had been out and, upon returning home, had found their mother lying on the kitchen floor, unresponsive. An abrasion on their mother's forehead and a bleeding tongue greeted them upon closer inspection. After finding a pulse but failing to arouse their mother with yelling and shaking her flaccid body, they called 911. They all rode in the ambulance to the ER. They later put together, with the help of the paramedics, that their mother had probably had an alcohol withdrawal seizure. "She tried to quit cold turkey a few days ago," the daughter continued, shaking her head, "and I told her she needed to go somewhere to get some help."
The mother, intently witnessing her children struggling, started crying as she spoke. "I haven't had a drink for two weeks, honey."
With her words, the son looked up from his feet. "No, Mom, that's not true. You were drunk just over the weekend." The mother offered no excuses to his words.
Just then, the room's curtain pulled open and in walked a middle-aged man, his face strongly resembling the children's faces in both looks and worry.
"Daddy," the girl exclaimed, jumping away from her brother and into her father's arms. "Hi Dad," the son added shyly, giving his father a brief smile before turning his eyes downward again. His pain was palpable.
"Hello, sir," I said, introducing myself, "you must be Mr. Smith."
"I am," he replied, thanking me for taking care of his ex-wife. He turned from me back to his children. "Are you both okay?" he asked, pulling them into his chest for a hug. I caught my breath at his genuine display of love and concern for his kids. It was just what they needed at just the right time.
The kids smiled and looked up into their father's eyes, nodding their heads "yes." Their worried eyes relaxed and I was able to see some small sparkles mirror off their reflection as they continued gazing at their father.
Before turning to a physical exam, I asked a few more questions. It turns out that this patient had an extensive alcohol abuse history. Eight years prior, she had successfully completed an alcohol rehabilitation program and had remained sober for six years, before succumbing to alcohol's temptations again just two years earlier. According to her children and ex-husband, the past few years had been "hell" and had affected all of their lives in a very gloomy, detrimental way. They were just nearing the point of giving up on her, I'm afraid, when two weeks back, the patient announced to her family that she was done with alcohol "for good."
"That didn't last long, though," the son added, "because she got drunk that very night and passed out."
On exam, this woman appeared very fatigued, both mentally and physically. She did have the forehead abrasion that the kids had noticed on their kitchen floor, her eyes nervously flittered horizontally (known medically as nystagmus) within their reddened borders, and her tongue, on the left side, was bitten. Her vital signs were stable and the rest of her exam was unremarkable. It was evident that she had had some type of seizure, most likely an alcohol withdrawal seizure.
We did a full work-up. Her head CT was negative, her labs reflected dangerously low levels of both magnesium and potassium (which we began immediately replacing via her IV), and her alcohol level was zero. Besides addressing her electrolyte imbalances, we also gave her IV multivitamins, hydration, and thiamine to protect her damaged body.
We admitted this patient, much to her family's appreciation. She needed specific medical attention for her alcohol abuse and withdrawal seizure. After arranging all of this, I went back into her room to find this patient and her family much as I had left them, with much love being shared between the children and their father and their mother quietly sitting in the cot observing her children. There was much sadness, for me, from the many facets of this scenario.
"Maam," I said, after reviewing her work-up and disposition, "do you want to stop drinking? Will you accept some help for your problem with alcohol?"
Her answer was music to my ears, and it came without hesitation. "I have to stop drinking," she said. "If not for me, I need to do this for my kids." She paused and looked at her kids, who were now watching her intently. "I love you both too much to continue on this path anymore." With those words, both kids gingerly walked over and wrapped their arms around their mother, the daughter now openly weeping.
How do I know this patient was sincere about wanting help? As I spoke to them about their options for several available in-patient rehabilitation programs, she seemed to be intimately familiar with most of the options. This mother had done her research and had begun taking her own steps toward sobering up and becoming the mother she could be to her children again. She appeared very sincere in wanting nothing more.
I looked at both children hunched over the railings on either side of the treatment cot as they hugged their mother. Despite the daughter's weeping and the son's hesitancy, I could see that their eyes, despite their sparkling and youthfulness just minutes earlier as their father had hugged them, had become edgy, wistful, and nervous again. Old and young and, unfortunately, back to old again, reflecting their aged, hurt souls.
I am not naive. I know it is going to take a lot regained trust and renewed love to keep these children's eyes permanently young. To erase the damage caused by their mother's alcoholism.
Then again, maybe I am naive, because a large part of me thinks that this mother can succeed. For her children's sakes, I can hope for nothing more.
As always, big thanks for reading. I hope your holiday weekend is a good one. Next posting will be Monday, July 5. See you then...
The pain of an alcoholic.
Standing in the corner, huddled together as a unified front, stood two teenagers. A boy and girl. Unlike their mother, they made no attempt to cover their worry. Their appearances were youthful--Converse Chuck Taylor sneakers, straight-legged jeans, graphic t-shirts, and hip stylish haircuts. But their eyes, those pained and aching eyes, bore an unfortunate truth to the years of sadness they had endured. Of their lost innocence.
I introduced myself to the patient before focusing my attention a little more closely on her children. Despite their worry, they were gracious in returning my hellos, introducing themselves.
I turned back to the patient. "Ms. Smith," I asked, "what happened that brought you to our ER this evening?"
Ms. Smith looked at me blankly, a confused haze slowly overtaking her face. I spoke again. "Do you know why you are here this evening?" She continued to stare at me, worrying me with her silence, before eventually nodding her head "no." She spoke. "I have no idea what happened."
I turned to her children. "Can either of you tell me what happened with your mother?"
The son stared down at his feet in response to my question. The daughter, however, connected with my eye contact and spoke up as she nervously tucked her wispy, blondish curls behind her ears. "I think she had a seizure." She got quiet then, her eyes getting more glassy as we continued to hold one another's gaze.
"Please, go on," I encouraged her and she bravely continued her story. She and her brother had been out and, upon returning home, had found their mother lying on the kitchen floor, unresponsive. An abrasion on their mother's forehead and a bleeding tongue greeted them upon closer inspection. After finding a pulse but failing to arouse their mother with yelling and shaking her flaccid body, they called 911. They all rode in the ambulance to the ER. They later put together, with the help of the paramedics, that their mother had probably had an alcohol withdrawal seizure. "She tried to quit cold turkey a few days ago," the daughter continued, shaking her head, "and I told her she needed to go somewhere to get some help."
The mother, intently witnessing her children struggling, started crying as she spoke. "I haven't had a drink for two weeks, honey."
With her words, the son looked up from his feet. "No, Mom, that's not true. You were drunk just over the weekend." The mother offered no excuses to his words.
Just then, the room's curtain pulled open and in walked a middle-aged man, his face strongly resembling the children's faces in both looks and worry.
"Daddy," the girl exclaimed, jumping away from her brother and into her father's arms. "Hi Dad," the son added shyly, giving his father a brief smile before turning his eyes downward again. His pain was palpable.
"Hello, sir," I said, introducing myself, "you must be Mr. Smith."
"I am," he replied, thanking me for taking care of his ex-wife. He turned from me back to his children. "Are you both okay?" he asked, pulling them into his chest for a hug. I caught my breath at his genuine display of love and concern for his kids. It was just what they needed at just the right time.
The kids smiled and looked up into their father's eyes, nodding their heads "yes." Their worried eyes relaxed and I was able to see some small sparkles mirror off their reflection as they continued gazing at their father.
Before turning to a physical exam, I asked a few more questions. It turns out that this patient had an extensive alcohol abuse history. Eight years prior, she had successfully completed an alcohol rehabilitation program and had remained sober for six years, before succumbing to alcohol's temptations again just two years earlier. According to her children and ex-husband, the past few years had been "hell" and had affected all of their lives in a very gloomy, detrimental way. They were just nearing the point of giving up on her, I'm afraid, when two weeks back, the patient announced to her family that she was done with alcohol "for good."
"That didn't last long, though," the son added, "because she got drunk that very night and passed out."
On exam, this woman appeared very fatigued, both mentally and physically. She did have the forehead abrasion that the kids had noticed on their kitchen floor, her eyes nervously flittered horizontally (known medically as nystagmus) within their reddened borders, and her tongue, on the left side, was bitten. Her vital signs were stable and the rest of her exam was unremarkable. It was evident that she had had some type of seizure, most likely an alcohol withdrawal seizure.
We did a full work-up. Her head CT was negative, her labs reflected dangerously low levels of both magnesium and potassium (which we began immediately replacing via her IV), and her alcohol level was zero. Besides addressing her electrolyte imbalances, we also gave her IV multivitamins, hydration, and thiamine to protect her damaged body.
We admitted this patient, much to her family's appreciation. She needed specific medical attention for her alcohol abuse and withdrawal seizure. After arranging all of this, I went back into her room to find this patient and her family much as I had left them, with much love being shared between the children and their father and their mother quietly sitting in the cot observing her children. There was much sadness, for me, from the many facets of this scenario.
"Maam," I said, after reviewing her work-up and disposition, "do you want to stop drinking? Will you accept some help for your problem with alcohol?"
Her answer was music to my ears, and it came without hesitation. "I have to stop drinking," she said. "If not for me, I need to do this for my kids." She paused and looked at her kids, who were now watching her intently. "I love you both too much to continue on this path anymore." With those words, both kids gingerly walked over and wrapped their arms around their mother, the daughter now openly weeping.
How do I know this patient was sincere about wanting help? As I spoke to them about their options for several available in-patient rehabilitation programs, she seemed to be intimately familiar with most of the options. This mother had done her research and had begun taking her own steps toward sobering up and becoming the mother she could be to her children again. She appeared very sincere in wanting nothing more.
I looked at both children hunched over the railings on either side of the treatment cot as they hugged their mother. Despite the daughter's weeping and the son's hesitancy, I could see that their eyes, despite their sparkling and youthfulness just minutes earlier as their father had hugged them, had become edgy, wistful, and nervous again. Old and young and, unfortunately, back to old again, reflecting their aged, hurt souls.
I am not naive. I know it is going to take a lot regained trust and renewed love to keep these children's eyes permanently young. To erase the damage caused by their mother's alcoholism.
Then again, maybe I am naive, because a large part of me thinks that this mother can succeed. For her children's sakes, I can hope for nothing more.
As always, big thanks for reading. I hope your holiday weekend is a good one. Next posting will be Monday, July 5. See you then...
Monday, March 29, 2010
The Good Roommate
The patient seemed like a nice enough kid. Really, he did. And I'm sure that before his socializing began the previous evening, he never dreamed that he would end up in the emergency room at 2:30 a.m. But, he did. He started the trend, the first of four college students that would come in during that overnight shift, drunk with a decreased level of responsiveness. And nothing else. No trauma. No assault. Just guilty of drinking too much alcohol.
One of the give-ins, I guess, when you work in an ER in a city that brags of having four colleges.
He was brought to our ER by his concerned, sober roommates. They were having a difficult time trying to wake him, despite their best efforts. And when they finally did wake him, he vomited all over their living room furniture and carpet. "We think he ate taco pizza," the roommate confessed to the triage nurse, painting us all an unfortunate picture.
The nurse and I walked into Room 29 after our triage team escorted this patient back in a wheelchair. His head was slumped to the side and he was sleeping. One roommate was with him, and he appeared quite frustrated with the patient.
Several of us were able to lift this patient from the wheelchair and into a treatment cot. Together, we removed his clothes, looking for any signs of trauma, before dressing him in a hospital gown. No signs of trauma. And no unusual findings.
Well, except for the big chunks of taco meat clinging to this patient's brush-cut. And his clothes. And his roommate's clothing, as well. Obviously, vomitus, by both its smell and look.
"What's going on?" I asked the roommate, on behalf of the nurse and myself. "Was he assaulted?"
"Oh, no, nothing like that," the roommate assured us. "He went to a party at another college and the people he went with dropped him off at our apartment like this. We couldn't wake him up and got scared so, after he puked all over, we drove him straight here." The roommate paused, looking like he wanted to add something else.
"Is that all?" I asked him.
"Well," the roommate spoke, quietly, as he picked some vomitus from his shirt, "I know it doesn't really matter, but he puked all over my car while we were driving here."
He was right. It didn't really matter to us. But still, that sucks.
The patient, breathing comfortably and in no apparent distress, was back to snoring. His vital signs remained stable. I think he simply wanted to sleep and be left alone. But no, I wasn't having any of that, yet.
"Hey," I yelled loudly in his ear while I rubbed his sternum, "wake up, buddy. You need to talk to us." Nothing. I grabbed a couple ammonia capsules, popping one under his nose. That did the trick. Those capsules always seem to come through for me.
He tried to shove my hand and the noxious capsule from under his nose. Purposeful movements--we like that in a patient. "What the..," he muttered, stirring his head from side to side. And suddenly, without warning, he started to dry-heave. Followed by more puking. Lettuce and salsa and orange cheese and hamburger meat. All over his gown. Never mind the looks, the smell was overwhelming.
"Wake up, buddy," I continued, side-stepping his line-of-fire, "you're in the emergency room." That news seemed to unsettle him a little. He looked up, glassy-eyed.
"What? What?" he muttered, wiping off his chin with his bare hand. "I said," I repeated myself, back to yelling in his ear again, "you're in the ER." He stared blindly ahead, before smiling a shit-eating grin. "Yeah, right." He turned his head to the side, closed his eyes, and started snoring almost immediately.
All the while, the roommate stood in the corner, shaking his head. "This isn't like him."
"Does he have a drinking problem?" I asked. "No," the roommate replied, "he's a good guy. He gets great grades. I'm not sure what happened tonight."
Well, the patient got an IV-catheter placed by the nurse. We infused a banana-bag, a liter of fluid that is mixed with multi-vitamins and thiamine. We also gave this patient two anti-nausea medications which seemed to control his barfing. We got control of things pretty quickly.
"What should I do now?" the roommate asked me, after things settled. I recommended to just grab a seat in the corner of the room, watch TV, grab a soda. "We'll have to observe your buddy and repeat his exam a couple times until he sobers up and is able to walk on his own in our hallways," I explained.
"Oh," the roommate said, "I can't do that. I can't leave my buddies to clean up all that puke in our apartment by themselves."
"Are you serious?" I asked, thinking back to my own college days. The basic rule then was that if you puked, you cleaned. It was that simple. I have some great college buds, but I would never expect them to clean up after me that way. Not that I ever got to that point. Really.
"If you could smell our apartment," the roommate said, "there's no way you would leave it until morning." Come to think of it, I guess our college house did stink occasionally.
The roommate left. The patient slept. Every hour, the nurse or I woke this patient to check on him, repeat his vital signs, and perform a stable exam. After three hours, he was much better. Awake and talking, able to walk the hallway and go to the bathroom on his own.
"What the heck happened?" the nurse asked him. The patient explained that there had been a very tasty punch at the party, one that packed a lot more than what he had expected.
"Did you eat taco pizza, too?" the nurse asked him, smiling.
"Yeah," he answered, "how did you know?"
The nurse smiled. "Oh," she said sweetly, looking at his soiled gown, "we have our ways."
The roommate had called twice while the patient had been sleeping. What a good guy, huh? By his second call, he had finished cleaning the apartment and his car, and was wondering how everything was going. "Just fine," the nurse told him, "in fact, you can come down and get him. He's walking around our hallways just fine."
We discharged this patient a half-hour later. Very stable. His alcohol level hadn't returned as high as we expected and, upon asking him, the patient admitted that alcohol wasn't the only thing he had abused at the party. We already knew that, though, from the toxicology screens. Like the nurse said, we have our ways.
The roommate proved himself to be a very cool friend, if you ask me. When he came back for the patient, he was genuinely concerned for his buddy and harbored no resentment to the fact that he had been puked upon, that his car had been soiled, and that his apartment had been messed up because of his roommate's choices. Mature beyond his college years, for sure. Or just knew the value of friendship, maybe. I did hear, though, that he had a taxi deliver them home, just in case the patient decided to spray more taco pizza all over the dashboard.
The good roommate turned out to be a smart roommate, too.
Maybe the patient will learn a thing or two from him. Just maybe...
As always, big thanks for reading. Next post will be Wednesday, March 31. See you then...
One of the give-ins, I guess, when you work in an ER in a city that brags of having four colleges.
He was brought to our ER by his concerned, sober roommates. They were having a difficult time trying to wake him, despite their best efforts. And when they finally did wake him, he vomited all over their living room furniture and carpet. "We think he ate taco pizza," the roommate confessed to the triage nurse, painting us all an unfortunate picture.
The nurse and I walked into Room 29 after our triage team escorted this patient back in a wheelchair. His head was slumped to the side and he was sleeping. One roommate was with him, and he appeared quite frustrated with the patient.
Several of us were able to lift this patient from the wheelchair and into a treatment cot. Together, we removed his clothes, looking for any signs of trauma, before dressing him in a hospital gown. No signs of trauma. And no unusual findings.
Well, except for the big chunks of taco meat clinging to this patient's brush-cut. And his clothes. And his roommate's clothing, as well. Obviously, vomitus, by both its smell and look.
"What's going on?" I asked the roommate, on behalf of the nurse and myself. "Was he assaulted?"
"Oh, no, nothing like that," the roommate assured us. "He went to a party at another college and the people he went with dropped him off at our apartment like this. We couldn't wake him up and got scared so, after he puked all over, we drove him straight here." The roommate paused, looking like he wanted to add something else.
"Is that all?" I asked him.
"Well," the roommate spoke, quietly, as he picked some vomitus from his shirt, "I know it doesn't really matter, but he puked all over my car while we were driving here."
He was right. It didn't really matter to us. But still, that sucks.
The patient, breathing comfortably and in no apparent distress, was back to snoring. His vital signs remained stable. I think he simply wanted to sleep and be left alone. But no, I wasn't having any of that, yet.
"Hey," I yelled loudly in his ear while I rubbed his sternum, "wake up, buddy. You need to talk to us." Nothing. I grabbed a couple ammonia capsules, popping one under his nose. That did the trick. Those capsules always seem to come through for me.
He tried to shove my hand and the noxious capsule from under his nose. Purposeful movements--we like that in a patient. "What the..," he muttered, stirring his head from side to side. And suddenly, without warning, he started to dry-heave. Followed by more puking. Lettuce and salsa and orange cheese and hamburger meat. All over his gown. Never mind the looks, the smell was overwhelming.
"Wake up, buddy," I continued, side-stepping his line-of-fire, "you're in the emergency room." That news seemed to unsettle him a little. He looked up, glassy-eyed.
"What? What?" he muttered, wiping off his chin with his bare hand. "I said," I repeated myself, back to yelling in his ear again, "you're in the ER." He stared blindly ahead, before smiling a shit-eating grin. "Yeah, right." He turned his head to the side, closed his eyes, and started snoring almost immediately.
All the while, the roommate stood in the corner, shaking his head. "This isn't like him."
"Does he have a drinking problem?" I asked. "No," the roommate replied, "he's a good guy. He gets great grades. I'm not sure what happened tonight."
Well, the patient got an IV-catheter placed by the nurse. We infused a banana-bag, a liter of fluid that is mixed with multi-vitamins and thiamine. We also gave this patient two anti-nausea medications which seemed to control his barfing. We got control of things pretty quickly.
"What should I do now?" the roommate asked me, after things settled. I recommended to just grab a seat in the corner of the room, watch TV, grab a soda. "We'll have to observe your buddy and repeat his exam a couple times until he sobers up and is able to walk on his own in our hallways," I explained.
"Oh," the roommate said, "I can't do that. I can't leave my buddies to clean up all that puke in our apartment by themselves."
"Are you serious?" I asked, thinking back to my own college days. The basic rule then was that if you puked, you cleaned. It was that simple. I have some great college buds, but I would never expect them to clean up after me that way. Not that I ever got to that point. Really.
"If you could smell our apartment," the roommate said, "there's no way you would leave it until morning." Come to think of it, I guess our college house did stink occasionally.
The roommate left. The patient slept. Every hour, the nurse or I woke this patient to check on him, repeat his vital signs, and perform a stable exam. After three hours, he was much better. Awake and talking, able to walk the hallway and go to the bathroom on his own.
"What the heck happened?" the nurse asked him. The patient explained that there had been a very tasty punch at the party, one that packed a lot more than what he had expected.
"Did you eat taco pizza, too?" the nurse asked him, smiling.
"Yeah," he answered, "how did you know?"
The nurse smiled. "Oh," she said sweetly, looking at his soiled gown, "we have our ways."
The roommate had called twice while the patient had been sleeping. What a good guy, huh? By his second call, he had finished cleaning the apartment and his car, and was wondering how everything was going. "Just fine," the nurse told him, "in fact, you can come down and get him. He's walking around our hallways just fine."
We discharged this patient a half-hour later. Very stable. His alcohol level hadn't returned as high as we expected and, upon asking him, the patient admitted that alcohol wasn't the only thing he had abused at the party. We already knew that, though, from the toxicology screens. Like the nurse said, we have our ways.
The roommate proved himself to be a very cool friend, if you ask me. When he came back for the patient, he was genuinely concerned for his buddy and harbored no resentment to the fact that he had been puked upon, that his car had been soiled, and that his apartment had been messed up because of his roommate's choices. Mature beyond his college years, for sure. Or just knew the value of friendship, maybe. I did hear, though, that he had a taxi deliver them home, just in case the patient decided to spray more taco pizza all over the dashboard.
The good roommate turned out to be a smart roommate, too.
Maybe the patient will learn a thing or two from him. Just maybe...
As always, big thanks for reading. Next post will be Wednesday, March 31. See you then...
Wednesday, March 10, 2010
Being Threatened
How many of you have a job where you could, at times, be physically or verbally abused? And threatened? And pushed beyond your limits of self-dignity?
Welcome to the ER.
Anyone who has ever worked in an emergency department or a trauma center has a story to tell about being threatened. It's not a good feeling and, in fact, is something that one can carry with them long after the event, dwelling on their minds and weighing down their hearts. We all, I think, have a little part of our self-worth damaged at times like that. And even though you did nothing wrong, you still ask yourself repeatedly "What did I do to deserve this?" or "Could I have done something different?" Nine times out of ten, that answer would be "no." But that crazy thing called guilt can flip the coin and make you feel like you were responsible.
For example, when an alcoholic or druggie comes in and threatens to "beat the shit out of you" or "find out where you live and come carve you up," it's par-for-the-course, something we have all been trained to deal with. We are asked to look beyond the abuse and realize that it's "not the patient talking" but, rather, the drugs and alcohol. Yeah, okay. For the most part, I can buy that. But we all have limits, and it takes tremendous professionalism and restraint to continue treating that patient. And of course, we always do.
Likewise, if a psychiatric patient presents during a crisis, a break from reality, they may lose the ability to discern between what is normal, accepted behavior and what is harmful, threatening behavior. And again, the ER staff is usually on the receiving end of their irrational actions or words. Recently, a schizophrenic patient sprayed us with her saliva while glaring at us with her distant, disconnected eyes, spatting away and trying to bite or hit anyone near her. Even after a face-mask was placed, she still managed to hurl some extremely hurtful, vulgar comments at our staff, particularly at a medical student who had some acne issues and a female guard who was not a size 8. One of our nurses ended up with a bruise.
Hell, about ten years ago, I even had a psychiatric patient tell me that he was going to find out where I lived and "take you out." I hadn't been the first doctor and I'm sure I wasn't the last that he threatened but, trust me, you don't sleep well after something like that.
We accept these words and these blows, these mean-spirited, personal insults delivered with flailing arms and legs, because we signed-up for our jobs in the ER. But, we are still human, and there are days when this type of threatening or abusive patient is harder to accept and deal with.
The hardest part, though, isn't the expected threats, such as from the above patients. Rather, it's the unexpected threats from the sane-appearing patient who decides to take out all of his frustrations on the ER staff. For this reason, I rarely let a patient get between me and the treatment-room doorway.
A while back, I signed on to treat a twentyish male who had waited for about two hours for a complaint of one week of cough and cold symptoms, exacerbating his asthma. He continued to smoke despite feeling that his symptoms were getting worse, per the nursing triage note.
As I walked down our brightly-lit corridor, towards his room, I exhaled a deep, thankful breath, happy to have my last patient survive her stroke. Unknowingly, though, I was walking towards a room of rage.
I pushed the curtain to the side and walked into the room, all while extending my hand to introduce myself. Lying on a cot in the dimly-lit treatment room, watching the small TV in the upper corner, was a young man who looked very pissed-off. He may have weighed 130 lbs. wet, 5'7" or so. After I entered, he shifted his glaring eyes onto me.
"Hello," I started, "I'm Doc..." Unfortunately, I didn't get to finish. In a flash, this patient had jumped off his cot and towards me, his arm cocked-back and his fist balled. He stopped a few feet in front of me.
"I had to wait almost three f...ing hours for you to get your ass in here. Can't you see I can't breathe?" He yelled in full sentences, no distress evident. By triage notes, he was stable and had had an excellent oxygen reading. There was no mention of this patient being unreasonable, although I later learned that security had to approach him in the waiting room to calm down. He continued. "You motherf...ers are treating everybody but me."
Yes, my heart was racing. And yes, I was completely caught off-guard. We had a brief moment of silence where our eyes locked, and I could see his extreme rage.
"Put your fist down," I said firmly, holding my ground, shifting my eyes to his cocked-arm. "If you touch me, I promise you that you'll be covered with cops and security before you can blink." Instinctively, while speaking, I raised both of my hands, preparing to catch or block a thrown-fist. Why didn't I retreat? I'm not sure, exactly. Although I had about 70 pounds and six inches on this patient, that would mean nothing if this guy had a gun or knife. But frankly, during a moment like this, it's hard to fully grasp all that is happening.
The patient continued to keep his arm cocked as he ranted. "Motherf...ckers, sons-of bitches, assholes," he yelled, "making me God-damn wait like this. I want some God-damn treatment and I want it now." Finally, after his rant, he took a step back towards his cot.
By now, because of the commotion, I knew that security would be rushing to the room. And they did, but not before one of our techs, a 350 lb. brute, came in first to back me up. Security soon followed and, after we offered some very brash options of either being arrested (if he continued his behavior) or cooperating or leaving on his own accord, the patient requested to be treated. Since I'm not easily intimidated and wasn't sure how ill he was, I agreed to treat him, but not until after I spelled out in exact terms how we expected him to behave. He hesitantly agreed to our terms.
Under watchful eyes, I obtained a history from this patient and performed a thorough exam. I tried my best to maintain my professionalism and act as if this patient hadn't wanted to jump me mere minutes before. Fortunately, I found him to be just as the triage nurse had noted. He had been appropriately placed behind our more critical patients for treatment.
The respiratory therapist came down, soon after, to give this patient a breathing treatment. Before she entered the room, I explained to her why security would be sitting outside of his room in the hallway. We both walked to the room together, only to find no security sitting outside.
"Go back to the station," I said, "I'm not sure what happened."
Well, as it turns out, this patient, following another angry outburst aimed at our security, had decided to leave without any further treatment. And wouldn't you know, the next day he returned. I wasn't even aware he was back until I heard a big ruckus. Again, a lot of verbal abuse towards one of the ER nurses and one of my partners. Our security was ready, though, and the police were notified.
Although we'll never know for certain, there did not appear to be any alcohol or drugs involved. No psychiatric history, either. He simply was a very disgruntled, angry man who wanted his medical treatment immediately, for symptoms that had been present for almost a week. In order to jump the line of waiting cardiac, stroke, and trauma patients, he had been willing to risk threatening several of us.
At times, we can face some real dangers with our ER jobs. My hat is off to all of my fellow ER comrades, from the secretaries to the techs, from the nurses to the docs, and from the security to the police. I salute your continued resilience and professionalism, especially during these abusive moments.
As always, big thanks for reading. The next post will be Friday, March 12. Until then...
Welcome to the ER.
Anyone who has ever worked in an emergency department or a trauma center has a story to tell about being threatened. It's not a good feeling and, in fact, is something that one can carry with them long after the event, dwelling on their minds and weighing down their hearts. We all, I think, have a little part of our self-worth damaged at times like that. And even though you did nothing wrong, you still ask yourself repeatedly "What did I do to deserve this?" or "Could I have done something different?" Nine times out of ten, that answer would be "no." But that crazy thing called guilt can flip the coin and make you feel like you were responsible.
For example, when an alcoholic or druggie comes in and threatens to "beat the shit out of you" or "find out where you live and come carve you up," it's par-for-the-course, something we have all been trained to deal with. We are asked to look beyond the abuse and realize that it's "not the patient talking" but, rather, the drugs and alcohol. Yeah, okay. For the most part, I can buy that. But we all have limits, and it takes tremendous professionalism and restraint to continue treating that patient. And of course, we always do.
Likewise, if a psychiatric patient presents during a crisis, a break from reality, they may lose the ability to discern between what is normal, accepted behavior and what is harmful, threatening behavior. And again, the ER staff is usually on the receiving end of their irrational actions or words. Recently, a schizophrenic patient sprayed us with her saliva while glaring at us with her distant, disconnected eyes, spatting away and trying to bite or hit anyone near her. Even after a face-mask was placed, she still managed to hurl some extremely hurtful, vulgar comments at our staff, particularly at a medical student who had some acne issues and a female guard who was not a size 8. One of our nurses ended up with a bruise.
Hell, about ten years ago, I even had a psychiatric patient tell me that he was going to find out where I lived and "take you out." I hadn't been the first doctor and I'm sure I wasn't the last that he threatened but, trust me, you don't sleep well after something like that.
We accept these words and these blows, these mean-spirited, personal insults delivered with flailing arms and legs, because we signed-up for our jobs in the ER. But, we are still human, and there are days when this type of threatening or abusive patient is harder to accept and deal with.
The hardest part, though, isn't the expected threats, such as from the above patients. Rather, it's the unexpected threats from the sane-appearing patient who decides to take out all of his frustrations on the ER staff. For this reason, I rarely let a patient get between me and the treatment-room doorway.
A while back, I signed on to treat a twentyish male who had waited for about two hours for a complaint of one week of cough and cold symptoms, exacerbating his asthma. He continued to smoke despite feeling that his symptoms were getting worse, per the nursing triage note.
As I walked down our brightly-lit corridor, towards his room, I exhaled a deep, thankful breath, happy to have my last patient survive her stroke. Unknowingly, though, I was walking towards a room of rage.
I pushed the curtain to the side and walked into the room, all while extending my hand to introduce myself. Lying on a cot in the dimly-lit treatment room, watching the small TV in the upper corner, was a young man who looked very pissed-off. He may have weighed 130 lbs. wet, 5'7" or so. After I entered, he shifted his glaring eyes onto me.
"Hello," I started, "I'm Doc..." Unfortunately, I didn't get to finish. In a flash, this patient had jumped off his cot and towards me, his arm cocked-back and his fist balled. He stopped a few feet in front of me.
"I had to wait almost three f...ing hours for you to get your ass in here. Can't you see I can't breathe?" He yelled in full sentences, no distress evident. By triage notes, he was stable and had had an excellent oxygen reading. There was no mention of this patient being unreasonable, although I later learned that security had to approach him in the waiting room to calm down. He continued. "You motherf...ers are treating everybody but me."
Yes, my heart was racing. And yes, I was completely caught off-guard. We had a brief moment of silence where our eyes locked, and I could see his extreme rage.
"Put your fist down," I said firmly, holding my ground, shifting my eyes to his cocked-arm. "If you touch me, I promise you that you'll be covered with cops and security before you can blink." Instinctively, while speaking, I raised both of my hands, preparing to catch or block a thrown-fist. Why didn't I retreat? I'm not sure, exactly. Although I had about 70 pounds and six inches on this patient, that would mean nothing if this guy had a gun or knife. But frankly, during a moment like this, it's hard to fully grasp all that is happening.
The patient continued to keep his arm cocked as he ranted. "Motherf...ckers, sons-of bitches, assholes," he yelled, "making me God-damn wait like this. I want some God-damn treatment and I want it now." Finally, after his rant, he took a step back towards his cot.
By now, because of the commotion, I knew that security would be rushing to the room. And they did, but not before one of our techs, a 350 lb. brute, came in first to back me up. Security soon followed and, after we offered some very brash options of either being arrested (if he continued his behavior) or cooperating or leaving on his own accord, the patient requested to be treated. Since I'm not easily intimidated and wasn't sure how ill he was, I agreed to treat him, but not until after I spelled out in exact terms how we expected him to behave. He hesitantly agreed to our terms.
Under watchful eyes, I obtained a history from this patient and performed a thorough exam. I tried my best to maintain my professionalism and act as if this patient hadn't wanted to jump me mere minutes before. Fortunately, I found him to be just as the triage nurse had noted. He had been appropriately placed behind our more critical patients for treatment.
The respiratory therapist came down, soon after, to give this patient a breathing treatment. Before she entered the room, I explained to her why security would be sitting outside of his room in the hallway. We both walked to the room together, only to find no security sitting outside.
"Go back to the station," I said, "I'm not sure what happened."
Well, as it turns out, this patient, following another angry outburst aimed at our security, had decided to leave without any further treatment. And wouldn't you know, the next day he returned. I wasn't even aware he was back until I heard a big ruckus. Again, a lot of verbal abuse towards one of the ER nurses and one of my partners. Our security was ready, though, and the police were notified.
Although we'll never know for certain, there did not appear to be any alcohol or drugs involved. No psychiatric history, either. He simply was a very disgruntled, angry man who wanted his medical treatment immediately, for symptoms that had been present for almost a week. In order to jump the line of waiting cardiac, stroke, and trauma patients, he had been willing to risk threatening several of us.
At times, we can face some real dangers with our ER jobs. My hat is off to all of my fellow ER comrades, from the secretaries to the techs, from the nurses to the docs, and from the security to the police. I salute your continued resilience and professionalism, especially during these abusive moments.
As always, big thanks for reading. The next post will be Friday, March 12. Until then...
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.
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.
Subscribe to:
Posts (Atom)
