The Dry Season

I wish it were simply a seasonal variance, the emergency department's environment of dry, humid-less air. A fifth season, of sorts, that would arrive between the last snowfall and the first flowers of spring. We could prepare, in advance, for the pruning process of our bodies, expecting and accepting every minuscule of body hydration to escape us during this period. Then, after a month or two of tolerating mosaic-like skin, we could move on to the next season.

Unfortunately, though, the ER's dry climate is a year-long season. The temperature-controlled, recirculated, skin-cracking air seems to be an everyday affliction. One that most of us have learned to deal with in our own little ways.

The answer could simply be to drink a lot of water. Which isn't easy, since free-time is a luxury in the ER. Remembering to take a drink is usually not a prominent thought during a crazy shift. Maybe the answer is lots of lubrication. Some people need to apply, and reapply, multiple applications of skin and hand lotions before and during a shift. A tube of moisturizing lippage never seems to be far from the typical ER employee. Despite all of these efforts, though, sometimes you simply can't outrun the gusts of stale ER air.

You will crack, my friend, you will crack.

How do I approach this problem? Probably much like most of my co-workers. I try my best to drink a lot of fluids, whether it is plain ice water or with a packet of flavoring mixed in. In the ER, though, sometimes it's just too hard to keep up. At times, even, I have completely forgotten to drink something until I urinate, for the first time, ten hours into my twelve hour shift, and notice my concentrated Sahara urine. Occasionally, we don't have our usual supply of water pitchers to make it easy for us to run to the ice and water machine. During these times, as I learned during residency, I resort to using a clean male urinal bottle to hold my iced water or, better yet, my urine-resembling iced tea. I've made a few people jump (freak-out, actually) from that move. But, hey, at least I am hydrating myself, right?

I also use my Aveeno lotion and my Burt's Beeswax lip balm faithfully and, still, I get dry skin and cracked lips. I have switched brand names to no avail. I have become intimately familiar with every option of every brand of moisturizer in our local pharmacy. I use nasal saline mist spray. And still, I crack. On a side note, I even tried slathering myself with Neutrogena body oil in the shower after I was done washing. Trust me, I didn't like that feeling of being all slicked-up, like a greased pig, for the rest of the day.

It is what it is, I guess, and comes with the territory of our jobs, being cracked and dry and parched. Two-bit impostors of some scaly crocodiles.

Which leads me to today's story.

Recently, while we were out, several of us were sharing some of our more embarrassing work stories with one another. I have enough of these stories to fill a book, actually (do me a favor and act surprised here), and will humbly share several of these stories along this blog's journey. Nothing makes me happier than when we can share and laugh at ourselves, embracing the fact that we too are human. Humble, modest humans. Self-deprecating and all.

Anyway, after the mention of the dry ER climate ("What the heck is up with that?" "Why can't they get a humidifier attached to the furnace?" and "Who gets cotton mouth at work?"), I decided to spill the beans of a time when I was in residency in upstate New York.

I was in my last year and had just finished a grueling twelve-hour shift, working from 8 p.m. to 8 a.m. It was one of those nights where the morning couldn't come quick enough. Lots of traumas, lots of cardiacs, lots of sickness. And lots of coffee. I don't think I had eaten or gone the bathroom the entire shift. It was one of those shifts you leave thinking that "Yeah, I got my ass kicked, but maybe, just maybe, I did make a difference during this one."

At eight, we gathered with the incoming team to sign-out our active patients. I was so dry, cotton-mouth and all, that I could hardly give my report without breaking every five seconds to lick my lips and try to swallow. After report, I went to our locker room and chugged five minutes from the bathroom faucet. Lucky I didn't catch anything. I applied my Chapstick and was on my way.

The drive home consisted of me taking two major highways, about five minutes on each, before exiting onto a country road and finishing the peaceful thirty minute drive. As I started out on the first major highway, I glanced at myself in the rearview mirror and noticed the big bags under my eyes. And then I gasped. Right there, dangling from my nose, was a cruddy, dried-out booger.

Or maybe it was the crumb-topping from a piece of apple pie. Oh, that's right, I didn't have a piece of apple pie with crumb-topping.

Well, I was mortified. Was that dangler there during sign-out? Or had it just been born minutes before while I was changing out of my scrubs? I felt like I should have given it a name.

Well, of course I couldn't let it just sit there. I had to get rid of it. Not an extra-napkin carrying kind of guy, I knew I wouldn't have any tissue in the car. So I just knocked it off, onto my car's floor. But did I stop there? Noooooo, not moi. I had to make sure there weren't any more. So, unfortunately, I did a very slight, superficial dig. Or maybe it was a quick side-swipe.

And that's when I got busted. As I was scratching and not picking, looking in my rearview mirror, I suddenly heard some relentless horn-honking. I looked to my left, out of my driver's window, and there were three college kids passing me in the left lane, all pointing at me and mimicking picking their nose. They were laughing quite hard, I must admit. And who could blame them? I would be, too, if I were passing a nose-picker in another car and was with two college buddies.

Well, of course, I had to laugh along, but not until after I cursed the dry ER. If only I had one of those misting fans attached to my neck ID tag, this might not have happened. And to add insult to injury, the back seat kid mooned me as they sped by. Can you believe that? The bastard! I'm okay with getting mocked, but I didn't like an unknown bare-ass giving me an 8:30 a.m. wake-up call.

I turned off the major highway onto the next one and, surprised not to have any cars in either lane, finished the swipe job. Took a big drink of my bottled water. Applied my chapstick. Laughed at myself. And hurried home to the welcoming arms of my wife, she who married a booger picker...

I don't think so.

And all because of the eternal ER dry season.

As always, huge thanks for reading. I hope you all had a great weekend. See you Wednesday, June 30...

The Pink Shiny Booger

It was late into the evening shift when I walked into a room to find a very embarrassed mother holding her toddler girl in the corner chair.

I introduced myself to Mom and then asked what brought her and her child to the ER this night.

"This," she answered, holding up a light-pink bead necklace. Mom explained that it was from a toddler game that involved spinning an arrow and collecting jewelry at various stops on the board. I am familiar with the game, actually, having won it a rare time or two against my kids (yes, my proudest moment as a father). Lucky for this little girl, I didn't have time to play tonight.

"Somehow," Mom continued, "Rachel broke the pink necklace and was able to pry apart several of the beads. Right before going to bed, we noticed this." With that, she placed her hand gently on Rachel's forehead and extended her neck, giving me a clear view of a smooth, shiny pink "booger" in Rachel's left nostril.

I had to smile. If you are a parent and have never had to deal with a foreign body in your child's ear or nose, consider yourself lucky. I'm knocking on wood, but we never had to deal with this problem, either. Something tells me, though, that I just jinxed myself. Rachel's mother, however, would not be included in this lucky group.

Rachel's mother continued to tell me everything they did to try to get this pink booger out. Q-tips. Tweezers. Tickling Rachel to make her laugh. Having her blow out of her nose. Hanging her from her feet for an hour from the house beams. Relax, just joking there. If anything, though, Mom felt their efforts may have made the bead go further up.

I taught Mom what to do at home if this ever happens again. Sit Rachel upright. Have her breath through her mouth. Have her take a deep breath in through her mouth and blow forcefully out of her nose, while plugging the unobstructed nostril. Sometimes, parents have even tried to blow forcefully in their kid's mouth to achieve the same response.

When all else fails, or if there is ever any struggle to swallow or breath, an immediate ER visit is necessary. With Rachel, who was quite comfortable sitting in her mother's lap, our options were simply to retrieve the bead with a suction-tip catheter, a hooked probe, or "alligator forceps," these very cool long-nosed forceps that reach easily into fairly tight spaces. Among the options for Rachel, we used the forceps first.

We got lucky with our alligator forceps on the first attempt. Rachel, cooperating and lying comfortably on her back in the cot, was a stellar patient. She let me reach into her nose and grasp the pink bead quite easily.

As I pulled out the bead, we all clapped for Rachel while she clapped along. Mom was relieved, obviously. Rachel, after getting an Italian ice and a handful of stickers, was discharged to home with an ENT follow-up appointment.

"That was too easy," the nurse commented as we watched Rachel and Mom leave.

An hour later, guess who was back. Yep, you're good--Rachel and her mother. They were requesting me.

I walked into the room, already laughing and shaking my head. "What happened?" I asked Mom.

If Mom was embarrassed before, now she was outright frustrated. "You'll never believe it," she started. "While we were here earlier, my husband cleaned up the game and swept the floor in Rachel's bedroom. When we returned home, guess (she nodded at Rachel as she spoke) who found a lone bead under her bed?"

I knew the answer. Mom continued. "I tried to do everything I could, but I just can't get this bead out. I am so embarrassed to be here again."

As she finished talking, Mom, being a good sport, started a laughing fit of her own. It was funny. "On top of it all," she continued, "Rachel couldn't be happier to be here again--she thinks she's getting more stickers and another ice." I looked down at Rachel, cuddling into her mother's lap, who returned my look with a sheepish grin. No doubt about it--she was cute as heck, pink booger or no pink booger.

Well, another bead, same nostril. We repeated what we did earlier to get Rachel's bead out and, knock on wood, it worked again. In my pretend stern voice, I told Rachel "no more beads." Mom was going to have to watch her like a hawk for the next few weeks. In fact, I think Mom wanted a pair of the alligator forceps to take home with her.

Needless to say, Rachel left without any new stickers or an Italian ice, at Mom's request. We understood completely. I was hopeful they wouldn't reward Rachel with a visit from the "pink booger fairy," either. Two bucks for two beads and I suspect they would become ER regulars.

I was happy when my kids outgrew that particular game--no shiny, colored boogers for my family, thank you very much. I'll take the yellow or green boogers any day. At least that way I know it will eventually either drip out or be swallowed. As for Rachel and her mother? I haven't seen them again since, but it I'm estimating correctly, I think Rachel is approaching the age where she'll start playing Monopoly soon. And Chinese checkers. And eating popcorn. And peanuts.

I'll be ready...

As always, thanks for reading...much appreciated. Next post will be Friday, January 15.