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...

It Wasn't Me!

Forgive my warped ER humor today...and big thanks to Dr. A for the awesome adventure/interview last night. He rocks. Find it here... Doctor Anonymous.

To the nurse who "expelled gas" in the nurses' station a few weeks ago and didn't fess up to it, I have just one thing to say. Shame on you! What would your mother say?! I hope you felt bad that night when you got home and thought back to how you just sat there, quietly, while I absorbed the blame and derision meant for you.

I was raised in a conservative, Catholic family. Seven of us kids with a loving mother and a providing father who, with gusto, cherished their traditional roles. Besides the obvious rules that accompany a Catholic background, we also had an 11th Commandment: "Thou shalt not expel gas in public." In my family, the "f" word stood for "farting." To this day, I still have more trouble with that word than the real "f" word. I'm not f...... kidding, either. If we did have to "release," we were taught to leave the room and find a private spot where you could wallow in your stink all by yourself. It's a rule I still try to uphold to this day, despite my wife making the best f...... chili I have ever had.

So, a few weeks back, I sat down in the nurses' station to catch up on a chart. It was an easy-going, friendly crew, consisting of three female nurses, a female secretary, and moi. Yes, I was the only guy in the vicinity. And, of course, I wouldn't have sat down if I knew what was coming.

We were all immersed in our work when, suddenly, I smelled something rancid. No, it wasn't a pine-scented plug-in. Or the industrial-strength apple-scented spray. I would have welcomed those scents. Instead, imagine a rotten egg mixed with a touch of skunk. Seriously, it was bad. I would rather have been sitting in a neglected Johnny-on-the-Spot than in that nurses' station.

I looked up, crinkling my nose and grimacing my face, hoping that it was a patient in a surrounding treatment room, one stricken with a lower GI bleed, rather than one of my coworkers. One of my female coworkers. No such luck. My coworkers were looking around as well, noses crinkled with as much disdain as my own.

We were all silent. And suddenly, the next thing I knew, I was being glared at by all four women, supposed friends, their eyes hurling their accusing daggers in my direction. It suddenly dawned on me what they were thinking.

"Oh, no," I said, shaking my head vigorously, "it wasn't me. I didn't do it. Don't assume that just because I am the only guy around, it was me."

I was met with silence and continued stares. I felt the overwhelming urge to explain my way out of this. "Seriously," I said, giving them my puppy-dog look, "I didn't do it. Maybe it was a patient or someone walking by in the hallway. Heck," I even chanced, "maybe it was one of you."

I was met with more silence. Frustrating silence. And more continued stares. Sneers, actually. If this was half as bad as a police interrogation, just declare me guilty and throw away my key.

Finally, I heard the secretary say in a low voice "Whoever smelt it, dealt it." Hey, come on people, be fair here! I "smelt it," alright, and I had the singed nasal hairs to prove it. But I didn't "dealt it." I promise. If we did an underwear check, I would have been cleared in an instant.

"Yeah," one of the older nurses added, smirking, "to think that one of us could do that!" She quickly darted her eyes away from me as I focused on her. Okay, at least now I knew which nurse did it. I stared at her just a brief moment longer, silently hoping (in that kind, gentle Catholic way) that she would choke on her Chex cereal the following morning.

Well, of course, there was no underwear check. No confessions, either. And I refused to leave. I was not going to let some wayward, XX stink-bomb embarrass me out of my seat. Go ahead and look at me, you four co-conspirators, and think whatever you want. I don't care. Okay, maybe just a little...

Of course, before the fumes could clear, the nurses' station became Grand Central Station. The neurology team, the cardiology team, the phlebotomists--they all passed through. Yep, they all crinkled their noses. Nope, none of them had the gall to address the stink with us. I refused to leave my seat. I'm not a stupid man--I knew the moment I left they would all be pointing their fingers at me. Finally, though, after what seemed like an eternity, I was able to appreciate the returning smells of moth balls and sanitizer and floor wax and vomit and illness--the glorious smells of our ER. Welcome back!

This episode, unfortunately, was not isolated. It's happened to me in an elevator, in my writing group, in a car, at the gym, getting a haircut, and so on. Surrounded by women, the guy will always be looked at with disdain. Am I right, guys? And every time it's happened, I've gotten this primal urge to jump up and down and declare my innocence. Which, of course, just makes me look all the guiltier.

I've even had one brilliant senior resident teach me the finer points of dealing with this issue when I was under his supervision as a medical student. "What you do," he said, "is find a room with a really old patient in it. Preferably a sleeping patient. Man or woman, it doesn't matter. Then you go in and, while you pretend to check their cardiac monitor, you let it rip." He was being completely serious. "The best part, though," he finished, extremely proud of himself, totally ignoring the disbelief on my face, "is when you come out, make sure you tell the nurse that you think their patient just shit them self."

Call me crazy, but I don't think that's really the answer. After giving it some thought, though, I think I've come up with the solution. Well, besides the obvious--hiring more male nurses (simply to reduce my odds of getting undue blame) and posting the 11th Commandment on every free inch of ER wall space.

The solution? A pin. A nice, big visible lapel pin. Round. I'm thinking fluorescent colors. A bold, clear Times font, set at 60. Ready to be pulled out and worn in an instant. And, of course, what it will read goes without saying.

"It Wasn't Me!"

As always, thanks for reading...next post will be Monday, March 1. See you then...one last shout-out to the famous and talented Doctor Anonymous. Thank you...