Pretty Gassy

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Pretty and gassy. Pretty gassy.

A pretty vulgar combination, if you ask me.

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

Save The Scowl

During yet another busy shift in our emergency department, our staff was on the receiving end of multiple scowls by patients and their families. None warranted, mind you, and none were taken personally. But, nonetheless, it seemed to be the theme of the day.

What started the scowling? Simultaneously, we had three ambulances arrive to our ambulance bay, within minutes of one another. A chest pain patient, a stroke patient, and a trauma patient. Our staff, always ready to rise to the occasion, planned our divide and conquer.

I treated the stroke patient. A 60 y.o. male, normally healthy except for his smoking history, had a sudden onset of slurred speech accompanied by some extremity weakness. His symptoms had started within the past hour and were witnessed by his wife.

"We were sitting in our Lazy-Boys, watching our favorite show, The Wheel of Fortune, when he started having these problems," she said, frightened. "Is he going to be okay, doctor?

We called a "stroke alert." Similar to treating a multiple-trauma patient or an actively-infarcting heart attack patient, we have an emergency response team composed of ourselves, an in-house neurologist, multiple nurses, and the IV team. Our goal? To stabilize a patient, get imaging studies (especially a CT scan), and intervene as quickly as possible. With the right circumstances, we have several treatment options that can reverse such devastating symptoms.

Well, my patient did have a stroke. His CT scans were negative for any hemorrhaging and he qualified for tPA, a clot-buster used very cautiously but effectively to treat ischemic strokes. Simply, this type of stroke is usually caused by an embolus (or clot) that travels to the brain, occluding an artery and preventing blood supply to the brain tissue beyond. tPA can dissolve this clot.

It worked. Within the hour that followed, all of my patient's symptoms resolved.

The cardiac patient went to the cath lab. Unfortunately, the trauma patient died. And, all the while, patients began to back up, waiting for their emergency care. This, I'm afraid, was probably the moment when scowling became an epidemic.

Outside our triage station (the nursing station where a walk-in patient is first greeted and evaluated), patients lying on cots started backing up, lining the hallway. A bad sign that we were getting crowded. Between the patients and their accompanying family members, you couldn't walk down that hallway without having several people give you dirty looks. This, despite them being able to see how we were all rushing around, working hard.

Several patients later, I walked into a very unforgiving room. Lying in the cot was an elderly man with enough piss-and-vinegar to last me a lifetime. Pacing the room, his son. Sitting in the corner, his wife. They were upset with their wait. They had been sent to our ER by their family doctor (so they said) for a problem that was chronic in nature. Specifically, continued urinary problems from an enlarged prostate. Nothing new, they simply called for an appointment and couldn't get one for a week.

"I don't understand how you can make people wait like this," the patient started, before I even had a chance to acknowledge their delay. After assuring them that we were all working quite hard, I simply focused on this patient's history and physical. All stable. With the delays in care, the triage nurse had ordered a UA and blood work, also normal. I explained in detail my exam and the results of these tests, reassuring the patient and his family that everything looked okay.

Three scowls greeted that news.

Finally, just when I thought the scowls were slowing down, a mother walked out of her child's treatment room, quite gruff, while I was handing a chart to our secretary.

"Can someone give me the access code for the internet? For some reason, I can't sign on," she said, clearly annoyed with her wait, her eyes rolling.

Wait a second. We give out turkey sandwiches and lemon pudding. We pass out warm blankets by the dozen. We reimburse parking. And we even have a TV in each private room. When did we start having available internet access for patients and their families? Did I miss something? Do we have a coffee bar I don't know about, either?

"We don't have internet access in the ER, maam," our secretary answered the mother. "Sorry about that."

The mother bore her angry eyes into us. And scowled. "That's ridiculous," she mumbled, before turning and stomping back into the room.

Eventually, during that shift, we caught up with our patient-load and the scowls lessened. In fact, I might have even seen a few smiles. Always a plus

Truthfully, the scowls don't bother me. Well, okay, maybe just a little. But only because they seem to be accompanied with a sense of entitlement. Yes, I understand that when someone is sick, it might be hard for them to comprehend that their symptoms may be less urgent than the next patient. We aren't minimizing the symptoms, simply prioritizing them. We are an emergency department. We don't ask people to come in. We would never deliberately make a patient wait. The scowls being given to us are for things that we, the ER staff, can't control.

Well, short of getting internet access in the ER, that is.

As always, big thanks for reading...next post will be Wednesday, March 24. Interestingly, as I finished this post, the health reform bill passed...more scowls to come...

"Yoo-Hoo"

As I sat down at my computer station to finish the chart on a patient I had just treated, I heard something quite interesting. A voice, smooth and mellow, was calling out.

"Yoo-hoo."

It was an older woman's voice. I was immediately taken back to when I was a child, in my grandparent's house, standing beneath a small, cottage-shaped clock that hung on the wall. With a new hour approaching, I held my breath, staring up at the clock, its small pendulum swinging beneath, clicking a constant, relaxed beat. Eventually, the clock chimed, a little trap door opened, and a small bird popped out and chirped it's greeting.

"Coo-coo. Coo-coo. Coo-coo." Three times, like clock-work (no pun intended). Standing outside of my memory looking-in, I saw the little boy in his summer shorts, his tanned face framed with shaggy brown hair, smiling as he looked up expectantly at the wooden bird that never failed to mark a new hour.

"Yoo-hoo. Yoo-hoo." The woman's voice snapped me back to the present.

I got up from my chair and followed the yoo-hooing until I was standing at the bedside of an elderly woman with matted soft-grey hair and empty hazel eyes. She clearly had dementia. She looked quite comfortable, though, and was mumbling something to herself between the yoo-hoos.

"Do you need help with something, maam?" I asked, straightening her sheets and tucking her in. "What can I get you?"

"Help me!" the patient screamed, "I need help."

This patient's nurse walked in just then, a younger nurse that I enjoyed working with. She was compassionate, knowledgeable, and hard-working. And apparently, at that moment, frustrated.

"Is everything all right in here, Victoria?" I asked, ready to help.

"Everything's fine. Mrs. Pello has Alzheimer's and was sent by the nursing home because the nurse there thought she was acting 'more demented' today." Victoria gave me a knowing glance. We both recognized the bullshit excuse by the nurse who sent in Mrs. Pello, trying to make her own shift easier. At our expense, of course.

"Anything wrong?" I asked. "You need me to see her?"

"Dr. P. picked up on her. We're just going to get some baseline tests and a CT scan of her head. If it's all good, she'll be heading back soon enough."

"Yoo-hoo," Mrs. Pello called out, yet again.

"On second thought," Victoria said, laughing, "if you can get her to stop yelling 'yoo-hoo' every five minutes, I would appreciate it."

"I kind of like it," I said. "It reminds me of a coo-coo clock my grandparents had when I was a kid. She sounds just like the little bird that popped..."

I was interrupted by Mrs. Pello. "Help me! I need help!" Her sudden outburst had caught Victoria and I both by surprise. Then, without pausing, Mrs. Pello continued. "Yoo-hoo. Yoo-hoo."

"Just wait," Victoria warned me, both of us chuckling, "you might like it now, but after a few hours of this, I'm not so sure."

Well, little did I know at the time, but Victoria had hit the nail right on the head. Mrs. Pello's loud "yoo-hoo" was methodical and rhythmic, an audio alarm that was set to go off every five minutes, interrupting our workday. Unfortunately, her door had to be left open so that the nurses in their station could keep a close eye on her. And the risks of sedating her outweighed the benefits. So her yoo-hooing would just have to be accepted for a few hours.

Soon after meeting Mrs. Pello, a middle-aged man, who had collapsed at home, was brought into our ER and placed in the room next door. His right side was completely flaccid (no muscle strength) and he had a facial droop. An obvious stroke. A stroke alert was called and we emergently intubated this gentleman, hooked him up to a ventilator, and aggressively treated his escalating blood pressure. This patient was critical.

And then, suddenly, in the midst of treating this crisis, there it was. "Yoo-hoo. Yoo-hoo." It was clear and resounding. Everyone who was involved in treating our stroke patient did a quick pause. "Yoo-hoo." Mrs. Pello had added another one for good measure.

"Come on, people, back to work," I said, reminding them of our task at hand.

"What the hell was that?" the neurologist and neurosurgeon asked me, intrigued. "You really don't want to know," I said, grinning. My ER team, including Victoria, was shaking their heads, obviously trying to stifle their laughs. Swiftly, we transferred the stroke patient to the OR for emergent surgery after his CT scan revealed a large hemorrhagic stroke--blood on the brain.

Unfortunately, treating the stroke patient delayed Mrs. Pello's own head CT and she continued to sit in her room, waiting. "Yoo-hoo." Yep, about every five minutes.

At another point, as a family passed by Mrs. Pello's room while being escorted to their treatment room, she started screaming out "Help me! I need help." The family's eyes widened from fright. The staff, immune to the cries, didn't even budge to help, which I'm sure thoroughly impressed this family. They had to have thought of high-tailing it and heading to another ER. Someplace where the doctors and nurses cared.

Eventually, though, Mrs. Pello went over to the radiology department for her head CT. We all cheered, looking forward to a few minutes of silence. Unfortunately, not even five minutes had passed before we got an urgent call from the CT tech. "Can someone come over right away? Mrs. Pello is screaming for help." Oops, someone forgot to warn the tech of Mrs. Pello's outbursts.

She returned from her CT scan and, thankfully, all of her workup was normal. She had been in our emergency department for approximately four hours. Well, not approximately. More like exactly! Even those of us not involved in her care were celebrating her finished work-up and immediate plans to be transferred back to her nursing home. However, due to several ongoing emergencies, it would be one more hour of waiting until the ambulance service arrived to take her back. "Yoo-hoo."

Even though I wasn't treating her, I couldn't help but go into Mrs. Pello's room several more times to make sure she was comfortable. You see, not only did her "yoo-hoo" trigger a wonderful childhood memory of that coo-coo clock, but Mrs. Pello herself reminded me of my grandmother, an amazing and fiercely-independent woman who also was stricken with dementia.

Victoria was dead-on right. After five hours of "yoo-hoos," Mrs. Pello's voice had lost most of its charm and smooth, mellow tones. Now, her cries were simply annoying. Our staff gave her a wonderful farewell, lining up in the hallway to witness her be escorted by the ambulance team back to her nursing home. I think they were just making sure that there would be no screw-ups--that Mrs. Pello was actually leaving. Do not pass go. Do not collect $200. Just get the heck out!

Me? Well, of course, I was missing Mrs. Pello and her "yoo-hoos" five minutes after she was discharged. It was too quiet! And truth be told, I don't think I was alone. I think we all were suffering from yoo-hoo withdrawal.

So, I took a deep breath, calmed my fears, made my voice smooth and mellow, and did it.

"Yoo-hoo."

Update: One week later...
Good news...you can hardly see my black-eye anymore. I just wish someone had warned me that Victoria knew karate!

As always, a big thanks for reading. The next post will be Monday, February 15. Happy Valentine's Day to all of you...

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Not A Hussie

The way our ER is designed, one of the patient treatment rooms, Room 15, sits directly across from a physician work station, a place where we can sit to do our charting, catch up on computer work, use a telephone, and review computerized radiographs.

We have several similar stations throughout the ER, but this one is unique because of the direct view it shares with Room 15. Despite our best efforts to keep the curtain drawn and the sliding glass door closed to this room, there are many moments when a patient and their family can "people-watch" us in the midst of a shift. I actually feel like someone might toss me some peanuts if I clap my hands and dance for them.

It works the other way, too. A screaming dementia patient can ebb away at your last thread of sanity in the middle of a crazy shift. The smell from a patient with a lower GI bleed can give you dry heaves, and the lingering apple-scented spray used to cover the smell only makes things worse. Even the conversations that are overheard, from critiques of the physical characteristics of our nursing and physician staff to the sharing of in-depth personal confessions and secrets, are enough to make one wish for an instant cement-block wall. Graffiti optional.

During one recent shift, because of the noise emanating from Room 15, I was quite happy not to be sitting at this particular station. One of my partners was, however, and I needed to talk to him.

As I walked down the hallway towards the station, the screaming and ruckus only intensified. I found the physician and connecting nursing station bare of any warm bodies and suddenly, I was worried about the happenings in Room 15.

I walked quickly into the room to see if I could be of any help. What I found was one of our recently-hired graduate nurses, Michelle, at the bedside of an elderly woman who obviously suffered from dementia. The patient was aimlessly yelling and aggressively trying to climb out of her bed. Michelle was struggling to get the patient back into her cot and despite her best efforts, this 100 lb. frail little lady was succeeding and now standing at the foot of her bed, all in the blink of an eye.

"Michelle," I asked, walking to the patient's other side as I spoke, "where is everybody? What can I do to help?"

"I think the patient in Room 18 crumped and everybody ran in to help" she answered. "Can you help me get Mrs. K. back into her bed?"

"Of course," I said, thinking this would probably be the easiest thing I would be asked to do during this shift.

Together, we tried to coax Mrs. K. back into her cot. Unsuccessfully. Mrs. K. had other ideas, I suspect, of taking a self-tour of our ER. It seems for every step back we convinced her to take, she took two forward. And she was a strong woman! Why does it seem that the more frail a patient appears, the bigger their can of whoop-ass? She was whooping us, no doubt about it. Heck, I thought, she wasn't even my patient!

Finally, I had had enough. Michelle and I were simply not going to win this battle. I work out often and although this woman's spirit was big, she did just weigh 100 lbs. So with that, I bent over, scooped up Mrs. K. in my arms, and easily placed her back in her bed. Problem solved. In fact, I suspect Mrs. K. enjoyed the ride. As soon as we got her back in bed, fluffed her pillow, and covered her with a warm blanket, she started napping, her outburst a thing of the past.

Guess what, though? After I picked up Mrs. K., I found my right arm, the arm I used to scoop her up, soaking wet.

"Michelle," I asked, "what do you think this is from?"

"Ughh, gross," she said, staring at my drenched arm. "Maybe she had an accident."

Do you think? I looked at my arm and my mind went rampant imagining what the wet was from. The best I could hope for was that it was something yellow. You gotta love Mrs. K. She showed me who was boss after all.

I went to our sink and scrubbed my arms with disinfectant soap. Twice. Three times. When I was done, I smothered myself in antimicrobial gel. That should take care of the juicing I just received.

Wrong. Soon after I returned back to my patients, I discovered a rash starting on my right arm. Only my right. The one that had the wet stuff on it. I looked at it and wondered, as you would, what the hell???

It was definitely a urticaric rash, better known as hives. What could Mrs. K. possibly have given me? Had she been a promiscuous hussie in her youth? Did her urine contain uranium? Was I allergic to recycled apple juice? I was cursing myself for being a good Samaritan. Was getting a rash on my arm worth this?

Of course it was. I would have helped Mrs. K. and Michelle again in an instant.

I went and washed my arms again. Twice. Three times. Then I took 50 mg of Benadryl and changed into a long-sleeved shirt.

I obsessively kept checking my arms. And after about fifteen minutes, I noticed something that made me feel a lot better. Made me smile, actually.

My left arm was getting a rash on it, too.

Why would I possibly be happy to be getting the rash on my left arm, too? Easy. If the rash were only on my right arm, then that unknown wet stuff would have been the source. But...if both of my arms were afflicted with the rash, then it obviously had to be from either the soap or antimicrobial gel I used. My left arm never had anything wet on it.

Washing my arms six times and smothering them with gel twice had gotten to me. Mrs. K., thankfully, had nothing to do with my affliction after all. And sure enough, after about an hour, the rash started going away. On both arms. Shame be gone.

Mrs. K., I owe you an apology. I didn't really think you were a promiscuous hussie in your youth. I promise. In fact, I really enjoyed meeting you as you reminded me of my grandmother. And wherever you are, I hope you are well and still showing the world your indomitable spirit!

Just not in Room 15.

As always, thanks for reading. Next post will be Monday, January 11th. Have a great weekend.

Another Notch In The ER Cot

I know there is a "mile-high" club for airplane travelers who are, to say the least, adventurous and daring. But is there a club I don't know about that involves an ER treatment room and the flimsy cot in it?

The other day, during another busy shift, I walked into Room 31, ready to treat a new patient. What I walked into, however, caught me off-guard. In fact, I think I blushed. And after everything I've seen and treated in the ER over these past years, to get me to blush is a major accomplishment.

Lying in the cot, covered by a thin papery sheet, was a very "loving", shall we say, young couple. They were in the midst of some passionate maneuvering--four tangled arms wrapped around one another, shirts rumpled and pulled up, shoes kicked off to the side of the cot, and mussed up hair. My timing couldn't have been better. Lucky me. A front row ticket to an amateur peep show.

Maybe in my twenties, I would have been more enamoured about this situation but, to be honest, I'm in my early forties now--the only thing I felt was a little frustration. And, guessing from my warm cheeks, embarrassment. Well, some wonderment too--who in their right mind looks around an emergency treatment room and gets "in the mood?" Is it the gowns? At least this explained why the room curtain and sliding door were closed.

I cleared my throat and skipped my usual greeting. 'What's going on in here?" I asked, trying to sound like my father, stern and all-knowing.

Surprised, the girl sat up. "Oh my gosh," she giggled, hardly embarrassed, "we got a little bored after waiting for so long to be seen."

"I'll tell you what. I'm going to step out of this room for one minute, and when I come back in, I expect you to both be presentable. If not, you will both be escorted out of the ER by security. Do I make myself clear?"

They both nodded their heads at me, the middle-aged doctor who interrupted their cheap thrills.

I walked back to the nurses' station shaking my head. I wasn't buying the bored routine. Each patient room has its own television, complete with a remote control and more cable channels than I get at home. Each room also has a filled magazine rack and its own telephone for local calls. We even have available wireless internet if someone is so inclined to bring in their laptop with them. Outside of a pillow, a warm blanket, and a two-day old turkey sandwich with fresh lemon jello, what more could a waiting patient want?

Obviously, some privacy. And some form of birth-control.

I found the nurse for Room 31 and after making her aware that our patient had just been actively trying to get pregnant in our ER, we both walked back to the room together. Maybe, we joked, they would name the baby after one of us.

The curtain and sliding doors were both open. We walked into the room. The twentyish male companion was sitting meekly in the corner chair, the patient in the treatment cot. They were both dressed.

This time, I introduced myself and their nurse. "So," I said, after introductions, "which one of you might be the patient? Because from what I walked in on earlier, I would think that neither of you is sick enough to visit us in our ER."

After some putzing around, we got to the reason. The patient, it turns out, had missed her period and came to our ER for a pregnancy test. Yes, I am being serious. She got sent to the ER's acute-care side instead of our express wing after telling the triage nurse she had abdominal pain, thinking it would get her seen faster when, in fact, it tripled her wait time. The triage nurse, trying to move things along, had ordered the pregnancy test and some basic blood work.

There must be a higher power--her pregnancy test was negative.

This whole scenario, though, got me thinking that maybe there was some club I wasn't aware of, a club that nobody filled me in about since they know I work in the ER. This isn't the first time I've caught a couple fooling around in a cot. It's happened before and I would be disillusioned to think it wouldn't happen again. The common denominator, though, seems to be that they are all younger people, ranging from their late teens into their twenties.

I guess that rules my wife and I out. Initially, after catching this last couple, I had started making plans to take my wife to our ER to spend the night and find out what we were missing. And I was going to splurge, yessirree. No regular treatment room for my honey. I was going to get us one of those big trauma rooms with the really sturdy cot. Warm blankets. Cable TV. Pack our own sandwiches and pillows. Get a baby-sitter for the kids. All I had to do was register one of us, embellish some medical symptoms, give our insurance information, and the room would be ours.

"Hey honey," I would have said, "pack up your suitcase and jump in the car. I'm taking you on an overnight excursion. You don't need to pack a nightgown, either. Where we're going, they have plenty of them." If those prospects didn't intrigue her, what would? "Oh yeah," I'd add, "don't forget our insurance cards!"

In the midst of all this planning, though, it hit me--I probably wouldn't get a good night's sleep in the ER sharing a trauma cot with my wife. And, as I think I mentioned, I am in my early forties now. I held both my hands out and weighed the situation. A good night's sleep at home versus joining some obscure "notch in the ER cot" club. I yawned as I thought about it and with my yawn, the answer came quite easily.

So, this brings me back to my original question. Is there an ER club similar to the "mile-high" club that I don't know about? Do I really want to know? And does it have a nickname? I do like "notch in the ER cot" but I made that up on the fly--I would hope the name would be something better and more original than that.

Finally, if any of you are members to either club, keep it to yourself. I don't want to know. Now, if you'll excuse me, I'm going to get a good night's sleep.

As always, thanks for reading...next post will be Friday, January 8th. Let me know if you think of any good nicknames...