Kung Fu Fighting

I love a distraction. Especially in the ER. Sometimes the distraction can be subtle and minor, one that I have to search out to find. Other times, though, a distraction can be glaringly obvious, practically smacking me in the face. Whatever the diversion, these moments can make a hectic, chaotic day in the ER much more tolerable. Not to mention fun.

Although it's usually the patients who provide the main attraction, occasionally it can be the waiting family or friends of the patient. For example, Aunt Alice's nose mole and smeared lipstick might make me do a double-take, detracting from the attention I would otherwise have given her nephew, the patient. Grandpa Ben isn't fooling anyone about his gas problem either, sitting over in the room's corner wearing a smug smile, shifting around on his chair before releasing another foul air biscuit.

The possibilities of distractions are endless and, quite frankly, most welcomed by my receptive self.

A few weeks back, I had a two-for-one zinger--both an intriguing patient and her entertaining boyfriend. The patient herself had a significant history of anxiety, bipolar depression, and schizophrenia and, while at an appointment at her mental health clinic, she had become extremely anxious and began to hyperventilate, ultimately passing out. This lead to her trip to our ER via the ambulance service. Her boyfriend, I was told, met her after she arrived.

Walking into Room 22, I found an anxious-appearing, thirty-ish, blond woman with extremely poor dentition. In fact, one of her front teeth was angled outward, barely hinged to her gums, and her tongue seemed to constantly caress this wayward tooth. Her blue eyes seemed out of focus, glazed-over even, probably a result of the valium given to her by the prehospital team. She fidgeted with her hands while her right foot rhythmically rubbed up and down her left shin. Her room smelled quite strongly of stale cigarette smoke.

Standing in the obscure corner of the treatment room was this patient's boyfriend. He was a small man, maybe 5'5", balding with a gathered ponytail. As I took his appearance in, he looked shyly down at his feet while pressing his hands together in front of him, prayer-like. Interestingly, he had no shirt on, just sandals and some worn jeans. His chest was sunken-in and fuzzy. His abandoned white t-shirt rested on the room's only counter top.

Between the two of them, I would have been quite content to spend the rest of my shift hanging out in their room, people-watching. I had a feeling that this interaction would be a memorable one.

The patient eyed me suspiciously as I approached her with my hand extended, ready to introduce myself. While in the middle of saying my name and explaining that I would be her doctor during this ER visit, I heard a loud exhalation followed by a hum originate from behind me, from the corner where the boyfriend stood. Quite frankly, it startled me.

I turned my head to look at the boyfriend, only to find him performing exaggerated motions of what I assumed to be some form of martial arts. After several moments of unorganized, flailing movements, he quit humming and folded his hands back together, bowing his head to me. Although I'm sure he didn't mean it to be, his actions and behavior were quite comical, and I fought myself from laughing out loud.

"Eddie," the patient shrieked, bringing my attention back to her, "cut that shit out. I ain't gonna watch your bogus karate while I'm lying here sick."

At this, Eddie began to hum loudly (again), keeping his head bowed, his hands folded, and his eyes closed. Suddenly, though, as if an "on" button had been pushed, he launched into another routine of air karate, randomly slicing and jabbing his hands while awkwardly kicking his feet outward. For his grand finale, he did a spin kick, almost tripping and falling to the ground on his landing. After collecting himself, he again folded his hands, bowed his head, and nodded to me before closing his eyes.

Funny, but I didn't feel threatened or in danger. I was, however, completely and totally mesmerized.

"Eddie," screamed the patient again, "if you do that one more time, I'm going to climb out of my bed and come over there to kick your ass. Got it?" Eddie apparently didn't, or else simply chose to ignore the patient's threats, remaining in his deep meditative state.

I tried to diffuse the situation. "Eddie," I said, smiling, "that's some really good stuff. Are you a professional?"

I had barely finished my question when the patient chimed in, laughing hysterically at my question. "Professional? You've got to be kidding!" she exclaimed, now choking on her words. "Hell, he's just making all of this shit up as he goes along."

"Well," I said, "his routine sure impressed the heck out of me." I was telling the truth, too. His routine was unlike any I had ever seen before.

With this, Eddie bowed forward again, I assume in thanks of my words.

"Bullshit," the patient said, emphatically, "he doesn't know shit about karate or anything else. Tell him, Eddie." I looked from the patient to Eddie and, after he remained silent in his own world, back to the patient again. "Oh, that's right, I forgot," she added, now sarcasm dripping from her words, "you don't talk during your karate sessions. How could I have forgotten?" She rolled her glazed eyes as she spoke.

Ouch. For her sake, I could only hope that Eddie would never try out his routine on her.

They became the couple of the moment in our ER. When they were alone in their room, there seemed to be a quietness, a calm, to the area. But the moment someone, anyone, walked into the room, the show began. A loud exhalation by Eddie. Humming. Eddie's routine of his remarkable abilities, capped off by his spin kick and landing. The bowing of his head and folding of his hands in conclusion. The girlfriend's free earful of screaming at Eddie for his ridiculousness. The exit of the person who entered.

The nurse walked out of Room 22, shaking her head and laughing after witnessing this same show that I did. So did the x-ray tech. And EKG tech. "Is this for real?" I heard several of our staff ask, after checking out the scene on their own.

"It is," I assured them.

After clearing the patient with a good physical exam and several tests, we quickly discharged her, if only to get Eddie out before he hurt someone or himself.

You can't buy a ticket for this stuff. And you surely can't make it up. The only thing you can do, really, is appreciate these distractions that come with a job in the ER. Well, that and closely inspect the room's corners to make sure there isn't a hidden camera trying to record your response for some reality TV show. That you've been set-up, somehow.

I look forward to the next distraction to arrive. Somehow, as sure as time keeps ticking, I know I won't be disappointed.

Hiiiiii-yaaaah!

As always, big thanks for reading. I hope you have a great, distracting weekend...

"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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