How Do You Sleep?

One of the more common, non-emergent complaints I hear in the ER is about sleeping, or the lack thereof. Although the patient is usually being seen for a more serious, emergent issue, if their sleep is not solid, they tend to skillfully bring it up regardless of what else is going on.

"Maam," I said, "it appears by your EKG that you are having a heart attack."

Despite chest pain so intense that my patient was clutching her chest, she still stammered, "But what can we do about my sleep?"

Or, imagine my elderly male patient in the midst of a stroke, with the left half of his face drooping, his speech slurred, and drool sliding down his chin. "I shant schweep adt nichte."

"Pardon me, sir, but what did you just say?" I asked.

Thankfully, the nurse starting his IV understood him. "He said, 'I can't sleep at night.'"

See what I mean? I've even had a patient share her insomnia issues during a pelvic exam. Maybe if she had slept more and fooled around less, I wouldn't have had to do this exam for her itchy, malodorous discharge in the first place.

Barring the situational, temporary reasons (for example, a death in the family), sleep disorders are typically viewed as chronic, long-term illnesses and, as such, should be treated by one's family doctor. Sleep studies may be necessary, and there are several options of treatment to prescribe, all requiring close follow-up. All reasons for me not to treat a patient for this disorder. I will, in a pinch, prescribe a few days worth of medication for a patient if their daily life is being severely affected, but that's about it.

Several years ago, after some prompting by my wife, I underwent a sleep study. It seems that I was having bouts of snoring and gasping for air in my sleep, per my wife. I'm not sure how she knew this, seeing that her head hits the pillow and a six-to-eight-hour coma immediately follows. But yes, she insisted, this was happening. So I took her word for it and pursued the testing.

I arrived at the sleep lab suite around 7:30 p.m, nervous and not sure what to expect. After checking in, I was shown to a huge bedroom, professionally decorated, with a queen-size, pillow-top bed beckoning for my company. "Come, Jim" it whispered to me, "come and let me wrap my big, down-filled arms around you." I think I heard the 40-inch TV calling, too, but I could have been imagining that.

After the tech showed me to my private bathroom, I changed into some appropriate sleepwear. You might be asking yourself--what's appropriate? I'm going to let your imagination answer that question. Just be aware, though, that they videotape you through the night as you sleep. And then post that video on YouTube. Just joking. Suffice it to say, I would suggest that one wear more than just the usual home sleepwear. And newer, too. Please, on behalf of all the sleep-lab techs in the world, don't show up in a stained, big-daddy Hanes t-shirt. Or tighty-whiteys. Or a moth-eaten thong. Or nothing at all. Especially nothing at all!

After changing, I climbed into bed. Soon, the tech came into the room. I was nervous, obviously, and likened this anxiety to how a 60 year-old fat, balding guy must feel while lying in his hotel bed, waiting for his prostitute to arrive.

The tech, a nonchalant, easy-going guy, explained the whole process to me. "First, we 'll attach these electrodes to your head, then your chest and finally your arms. After that, we'll leave you alone. You can do whatever you want--watch TV, read a book, whatever--until around 10 p.m. If you aren't sleeping by then, we'll ask you to turn off everything. Don't forget," he continued, "besides monitoring you, we'll be watching you on video." He pointed to the cameras in the upper corners of the room while he spoke. "Any questions?"

No questions, but just a silent prayer. "Dear God, I beg of you, keep me from scratching myself or making a fool of myself tonight. Amen." I added a bargain for good measure. "Oh, and if you do, God, I promise to give every ER patient a turkey sandwich, a warm blanket, and unlimited lemon pudding during the next week."

The tech left the room. I looked around, all this comfort surrounding me, and all I could do was think "How the hell am I going to sleep with all these wires hooked up to me?"

Well, I read a little, I flicked through the 1000 available TV channels, and finally, around 10 p.m., I turned off the lights. There's no way, I thought to myself, that I'm going to fall asleep. I pictured my wife at home, smiling, arms and legs spread out, sleeping soundly alone in our bed. I had the bad feeling that I had been set up.

Next thing I knew, though, I was being nudged in the shoulder. "Hey," I heard, "it's time to wake up." Through groggy, squinting eyes, I peered slowly around, clearing my mind's disorientation. That's right, I reminded myself, I was in the sleep-lab and, wouldn't you know, just had my best night's sleep in about ten years.

"You did great," the new male tech said. "Let's get you up and out of here." I got up, moved to the side of the bed, and he removed all of my electrodes. I got a quick shower, cleaning all the gel off of my head and body, brushed my teeth, got dressed, and headed home. I didn't need to hear the official results, I already knew--everything would come back normal.

Yeah, well, I'd like to call a penalty--the sleep-lab guys cheated. Unlimited channels, private room with bathroom included, big pillow-topped bed with down-filled comforter, the bed all to myself--who the heck couldn't sleep within those luxuries? The wires were but a mere distraction.

Have any of you had a sleep-lab study done? Similar experiences? Would you like to share how it went? What you wore? Let me lower my voice three octaves, like the great Barry White's, to a whisper and ask again. "Hey you, yeah you, how you doin'? What did you wear during your sleep lab?"

It took me some time, but I have my sleep all figured out now. Three, no four, things work for me. One, no alcohol. It's been shown to interrupt your sleep cycles, so I cut out my nightly glass of wine. Two, a great book. Three, Tylenol PM. Just one, occasionally. And four, in a pinch, 1/2 of a 10 mg Ambien tablet. I still have half of a thirty-day supply prescribed from last November. Take it on an empty stomach and within a half-hour, I'm a little woozy. Next thing I know, I wake up and it's morning time. And life is good. Bring on the day!

This isn't medical advice, just what works for me. Sometimes, though, it works too well. After taking a Tylenol PM several nights ago (I'm in the midst of several busy ER shifts), I woke up the next morning, horrified. On the ottoman beside our bed, my laptop computer sat with the top opened. Here, after taking my Tylenol PM, I had the brilliant idea to email a few people about their kind comments left on my blog. Rereading those emails this morning, I could only laugh and send those readers a follow-up email, apologizing for the ramblings. Forgive me if you got one.

Okay, I gotta run. I feel the Tylennnnnolll PPPPPMM kkickkkkkingggg innn aaagainnnnnnnn. Seriously. As we used to say when I was younger, "Good night, sleep tight. And don't let the bed bugs bite."

As always, big thanks for reading. Next post will be Wednesday, March 10. See you then...

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...