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...

A Love Story

Before today's post, some quick business to take care of...

To my awesome readers, to Medgadget, and to Epocrates...I am truly appreciative and honored to have won the 2009 Medgadget Best Literary Medical Blog Award. Hell, I was tickled to just be nominated and ecstatic to have been chosen as a finalist. But to win? This is a very cool and distinguished award that has been bestowed upon my blog, and I thank all of you. Congratulations to the other finalists, as well. You all rock! I am humbled by the attention.

Big thanks, all, for also supporting my blog as a finalist in the 2009 Medgadget Best New Medical Blog category. The competition was fierce and I feel fortunate to have been included within that fine group of weblogs. Congratulations to the winner, SCOPE! Well done!

A special thanks to several people for my early nominations...Mike from Life In The Fast Lane, Ramona from Suture For A Living, Sunil, and Chrysalis Angel. Continued thanks to my (intelligent, faithful, and funny) readers for always being supportive of my blog, from your personal emails to your insightful comments, from your blogrolls to your tweets. You guys make me feel like I've accomplished something special. Thank you, my friends...

Finally, this Thursday, February 25, 2010, at 9 p.m., I will be a guest on the Dr. Anonymous Show, a live internet "BlogTalkRadio" show produced by a heck of a cool guy, Dr. Mike. This will be a new adventure for me and I look forward to the experience. If you have a chance to tune in, please do. And thank you, Dr. Mike, for the opportunity. I just hope I don't screw up...

The post that follows describes a gifted moment that I was fortunate to witness last week in our ER. I proudly share the story with you...

A Love Story

I noticed the two of them shortly after I arrived for my shift. I was standing at the counter, immersed in a chart, when out of the corner of my eye, I saw them walk out of their treatment room. Together.

Slowly, they walked into the hallway, looking first to their left and then to their right, wondering which way to go. One of them pointed down the hallway, grabbed the other's pale hand, and they began to walk toward their destination.

They were obviously in-sync and comfortable with one another, leaning into one another with each step. They continued to hold each other's hand as they approached me, and my eyes locked onto their steadfast grip. As they neared where I was standing, I smiled at the both of them and was rewarded with a return smile from each, doubling my investment.

"Can I help either of you?" I asked, studying their faces as they gave me their attention. Faces etched with contentment.

"No, thank you." It was said in unison. "We're just heading to the bathroom," added the one.

They passed me at a slow pace, and I continued to watch the caring that was quite evident between the two. It was my privilege, really, to observe and absorb their abounding love and obvious comfort with one another, something I don't see nearly enough in my job.

The bathroom was just thirty or so feet past me and, with no pressing patient concerns, I decided to continue watching. Their entwined hands, which had mesmerized me on their approach, looked even more beautiful and innocent, swinging in unison, as they passed and continued down the hallway, away from me. They were talking, hushed, and I noticed how their conversation was steady. Occasionally, one would steal a glance at the other.

They made it to the bathroom. The one gingerly pushed the door open for the other, helping him into the room before stepping back out into the hallway and shutting the door. Several minutes later, after some brief privacy and a few loving knocks, the door opened and they reunited. Hands were reclasped. Smiles were exchanged. Gingerly, they made their way back down the hallway, towards me and their room. Passing by me again, they both nodded.

We exchanged pleasantries. "Have a nice day" was met with "And the same to you." I wanted to say so much more, but decided to just enjoy this moment.

They passed me and I turned to watch their final few steps. Ginger steps that were unhurried and conscious. Again, hands were swung, bodies were leaned into, and familiarity enveloped their every move. I basked in their uniqueness, their special bond, hopeful that they realized just how blessed they were to have one another.

They arrived at their door and, just like with the bathroom, the older gentleman walked into the room first. Helped by the other, who followed.

How blessed was I to witness this true love story. Between...

An elderly father and his grown son.

As always, thanks for reading. Next post will be Friday, February 26. See you then...

The Thong Expert

I had no idea that I, a small-town, naive, aah-shucks kid, would become a thong expert. For better or worse, though, thanks to my job as an ER physician, that's exactly what I've become. Just don't look for that entry on my resume!

I was attending medical school, in Philadelphia, the first time I walked into a Victoria's Secret. I was with two of my buddies and we were on the hunt for something sexy, something hot, something that would tell our girlfriends that yeah, we might be medical students, but we were hip medical students. Good luck trying to find the nerd in us that Valentine's Day!

I had never been in a Victoria's Secret before but, because my buddies seemed real comfortable about the whole thing, I tailed them through the front door. "The secret," they confided, "is not to touch anything."

I lasted less than five minutes. Okay, I'm lying. It was more like five seconds.

I felt like I should have paid a cover charge, my bobble-head taking in all the life-like mannequins modeling the newest underwear trends. I could have sworn one of them winked at me as I was checking out the intricacies of her lace borders. Easily my lowest point ever on the wishful thinking scale.

Not paying attention to where I was walking, I knocked into a table loaded with skimpy undergarments. Luckily, though, I was able to catch myself and right the table before we both hit the ground. Like a klutz, I tried to straighten a few piles of panties before giving up, realizing that never again would I hold ten thongs in my hands at one time.

My face felt flush. Ebbs of desperate sweat trickled down my back. I took a deep breath and recovered slightly. Keeping it cool, I continued walking down the aisle, pausing here and glancing there, sure that I was looking more and more at home.

My confidence, however, was short-lived. Directly in front of me, approaching, was a pretty girl with a Victoria's Secret pin on her lapel. Brandy, it said. I turned and looked behind me, hoping I wasn't the one in Brandy's line of fire. No such luck.

"Hello, sir, what can I help you with today?"

"Um, well, I um, well--I'm looking for a Valentine's Day gift for my girlfriend," I stammered.

"That's easy enough," Brandy said enthusiastically. "What size is she?"

What size is she? What size is she? WHAT SIZE IS SHE? Shit, I had no idea.

"Um, I think, well, um...I'm not sure," I said, now definitely feeling a little woozy.

Sliding her hands down her hips, Brandy asked innocently, "Is she my size?"

What??? Was this an open invitation to check her out? Did I need a coupon for this?

I passed on Brandy's invitation. "Yeah, well, I think she is," I said, eyes downward, feet pacing side-to-side. "I'm not feeling all that great, though," I mumbled, trying to escape, "so I'm going to go out in the hallway and sit down for a minute. I'll be right back." Yeah, right. Liar.

Thus, my history with Victoria's Secret. Needless to say, Karen (my eventual wife) did not get a VS outfit. I'm good for chocolate and jewelry and wine, but if she wanted a guy to buy her those skimpy outfits, she married the wrong one.

How does this relate to my life in the ER? Well, with as many thongs as I have seen in the ER, sometimes I wish I had been born in a Victoria's Secret. Then I wouldn't be so caught off guard, so queasy, each time I saw one.

Especially on a guy!

Recently, after hearing a trauma alert called for Room 29, I ran into the room to find a very belligerent middle-aged male, quite intoxicated, with multiple contusions and abrasions to his face. A victim of a barroom assault, per the paramedics. He was being both verbally and physically abusive to our staff, aggressively swinging his fists and kicking his legs at several of us. Another drunk tough guy talking big and hitting low.

We were unable to calm him down, despite our best efforts. Not knowing if he had any life-threatening injuries, we chemically sedated and paralyzed him before emergently intubating him, hooking him up to a ventilator. This ensured our safety from his flagrant behavior while we got a more thorough physical exam and ran the appropriate tests, all in a calmer manner.

After stabilizing this gentleman, one of our newly-hired aides began removing this patient's clothes so we could do a fully-exposed physical exam.

Now, picture it. Balding, middle-aged man. Scruffy, ruddy face. Gold-plated incisor. Carhartt jacket. Flannel shirt. Wrangler jeans. Steel-toe boots. All coming off.

The aide cleared his throat. I looked up to find him blushing. "Does this come off, too?"

Everybody stopped what they were doing and our eyes followed his. Oh no! This patient had on one of the skimpiest candy-apple red thongs that any of us had ever seen, frilly-lace included. And although I didn't know what size this patient wore, I would bet the thong was too small, evident by both of his testicles hanging out on either side of its sparse fabric.

I know, fricking gross. That's what I thought, too. I imagined connecting a cable between them so they could catch up with one another. Can you imagine that conversation?

"Hey, Leftie," his right testicle would say, "can you believe this asshole? Packing and suffocating us in this thin, red snatch of flimsy fabric! I'm pissed!"

"Hell, yeah. This better be the last time or I'm outta here. It's nice to breathe again. That damn thing was pressing me right low to the brown hole."

Needless to say, after the appropriate gawking was done, we cut the dainty, delicate undergarment off this patient and placed it in its own clear plastic garment bag to give to his family. The nurse placed it smack on top of his pile of possessions, no less. Accidentally, I'll assume. (Side note here--always be kind to your nurse and never, ever spit at them!)

Based on his wife's expression when the nurse handed over his clothes, this patient had some serious explaining to do. I could only imagine his testicles' flagrant screaming for mercy when she got done with them. At least, to this guy's credit, he didn't have a matching "tramp stamp" tattoo in the small of his back.

Soon after that day, I was at our local mall and passed by Victoria's Secret. Sadly, despite all the skimpily clad mannequins, all I could picture was a near-naked guy in a red thong sitting on a rickety bar stool guzzling Budweisers and slamming back shots of Jim Beam.

And they wonder how we in the medical field get jaded!

As for my wife, well, she'll just keep getting chocolate. And jewelry. And wine. And a pair of Hanes granny panties. Again.

As always, thanks for reading. Next post will be Wednesday, February 24. See you then. Big thanks for all your support and votes in the recent Medgadget Medical Blog Awards!

A Mother's Cry

It happened again last week. Among the hustle and bustle of a crazy shift. A pre-hospital radio call from an ambulance team that nobody ever wants to receive.

"We're bringing you a child in cardiac arrest."

Noooooooo. Word traveled quickly through our staff, and the mood immediately got very somber as everyone prepared the resuscitation room for this child. We could only pray that the child being brought to us would respond to our life-saving measures.

Nurses ran to get the intubation and IV trays, pharmacists ran to get the resuscitation cart with all the emergent medications, techs ran to get the EKG and ultrasound machines, and respiratory therapists ran to get a ventilator. Two of us physicians were working with a slew of residents, and we all reviewed our mental checklists and tried to enter our objective frames of mind. Organized frenzy.

My partner requested to be the lead physician during the resuscitation. Being young and recently-trained, he wants to save the world. We all want to save the world, I guess, but for now we'd focus our energy on saving this child. I assured him that I would stay in the room and help with the resuscitation efforts.

The ambulance arrived. With a sad nod of his head, a trusted paramedic gave answer to our searching faces. No response. Yet. We all caught our breath as our hearts plummeted.

We transferred this child to our hospital cot. We emergently intubated this child, checked for any pulses, and continued CPR when we found none. IVs were hard to establish, so I started an intraosseous line by sticking a needle into this child's left tibia. Aggressive fluids were given. Medications were administered. Ventilations were forced into uncooperative lungs.

Efforts continued. My partner followed the life-saving protocols but didn't get any response from this child. Prayers were whispered. Seconds were watched as they ticked on the clock. Slowly, as slow as any time had ever passed, a heartbreaking realization permeated the room. We might not succeed.

My partner ran to the family room to discuss options with this child's parents, while I continued to follow all the resuscitation protocols. We had nearly maximized all of our medications. And still...nothing. CPR was continued, ventilations were continued, more medications and hydration were given.

My partner returned to the treatment room. He looked at me expectantly, and I shook my head "no." My partner shared his conversation with me. Dad was still at work, and Mom was in the family room with our social workers, waiting for family to arrive. She had been invited back to watch the resuscitation efforts, but declined. Her child had been through this once before, because of chronic, ongoing medical problems, and had survived. Surely, she thought, her child could survive again.

After almost an hour of failed heroics, with absolutely no response to any of our interventions, we confirmed what we were most afraid of. There were no palpable pulses. There was no cardiac activity, confirmed on monitor and with our bedside ultrasound. There were no spontaneous respirations. There were no signs of life from this child.

There would be no miracle.

My partner asked if anyone in the room objected to his prounouncing this child's death. Nobody objected, since we had all been involved in trying to save this child's life. We knew the efforts that had been put forth were monumental. No attempt had been spared by our team to bring this child back. Unfortunately, and for unexplained reasons, the fates held different plans. My partner announced the time of death.

I requested a nurse to clip some of this patient's hair for the family. I crossed myself after my silent prayer. I fought my tears. Hell, we all fought our tears. I consoled my partner, who, like me, has three young kids of his own. Slowly, a wave of profound sadness and nothingness swept across us. What good are any of us if we can't save a child's life? My partner went out to the family room to deliver the awful news.

Then, time stood still. From two hallways away, I heard the haunting sound. A sound that I knew was coming. A sound that is played over and over in my mind for days after an event like this. A sound of profound anguish. A sound of utter disbelief. A sound of infinite pain.

A mother's cry.

Slowly, as we all knew would happen, the mournful wails of crying crescendoed, and our emergency department came to a stand-still as Mom was escorted through our halls into her little child's room.

Despite our best attempts at maintaining our objectivity, and despite the fact that there were many more patients waiting to be treated, our ER staff cried collectively and gave consoling hugs to one another. We are mothers. We are fathers. We are brothers and sisters. We are sons and daughters. We are friends. We are human. And, we were broken.

Dad arrived just minutes after Mom was escorted to the room, and the cries of desperation were repeated. This time, husky and deep. Slowly, though, his cries softened and dissipated, until there was but one lone cry that began again. Higher-pitched. Guttural. Primitive. Emanating from the womb. A cry that conveyed the raw anguish and helplessness that only such a profound loss as losing your child could bring.

God Bless this mother. God Bless this father. God Bless this child. And may God Bless and watch over this family. And all of us.

If only life were filled with just happy moments...As always, thanks for reading. Next post will be either Friday, February 19, or Monday, February 22. See you then...

Saltines & Candy

When I was a kid, I used to love saltine crackers. Love them! Give me a handful of candy or a handful of saltines, and I want those crackers. Every time. In fact, I was that little kid knocking on the neighbors' doors, asking for hand-outs, especially when Mom was making something that I didn't like for dinner. Which was rare, since Mom thrived in her kitchen, but it did happen. Have you ever had salmon parmigiana? Yep, I know. It even sounds gross. That lone entree was responsible for making me a saltine beggar, all by the age of eight.

My kids find my stories of begging for saltines fascinating. Especially since times have changed. I think I would tickle-torture my kids if I ever found out they were knocking on our neighbors' doors, asking for something to eat. They can't even begin to fathom that I, their father, knocked on Miss Lindy's or Miss Margie's front door and asked for a hand-out. After finally accepting that part, however, they just simply shake their heads at my stupidity for asking for saltines and not candy.

"Wait, wait," my oldest asked, incredulous, "so you mean you just stood there, knocked on the door until they answered it, and then just asked them to give you some crackers? Like, you begged for them?"

"Yeah, that's about it in a nutshell," I said. I swear I saw the two younger kids taking notes in their notebooks. "Dad," my youngest asked, "how do you spell 'begging?'" Yes, they were definitely taking notes.

"So, Dad," my oldest continued, "did they ever say 'no?' I mean, come on, they didn't really give you crackers every time, did they? "

"Well," I answered, ready to have some fun, "maybe once in a great while they would say 'no.' But you have to understand, I was a cute kid. I mean, really cute. It was hard to say 'no' to me."

All three of my kids rolled their eyes. I thought their synchronization was excellent until I looked over at my wife, leading the pack. She should be ashamed of herself!

"Well, I was!" I exclaimed, defensively.

"Maybe that's why they only gave Daddy the saltines," my wife chimed in, "they saved the candy for the really cute kids. Oh, and by the way, kids, did you know I used to get tons of candy from our neighbors when I was little?" Yeah, right, I thought, shaking my head. My wife can be one funny lady sometimes.

So, with much fondness and love for the basic saltine, I couldn't wait to treat a patient who arrived by ambulance at the end of my shift a few weeks back.

The chief complaint listed on the patient's chart was "Patient choked on a cracker." Hmmm, it sounded kind of serious. However, when I walked into the patient's room, all I found was a middle-aged, poorly-kept, obese gentleman sitting in the hospital cot flicking TV channels with the remote.

"Sir," I asked, after introducing myself and clicking off the TV, "what brings you to our ER tonight."

"Well, I was eating a saltine and it was kind of dry, and it made me gag." Well, yeah, I thought to myself, saltines are dry and they can make you gag, I guess, if you eat enough of them or eat them fast. But, can you still whistle?

"Okay," I said, trying to understand a little better, "so what made you come to our ER?" This guy was speaking full, clear sentences and had no obvious breathing or swallowing difficulties. I needed to figure out what was the emergency.

"Well," the guy said, "after I gagged on the dry cracker, my throat was a little scratchy. I feel better now, though."

Wait a second here. So this guy ate a saltine, gagged on it because it was dry, and then called an ambulance to transport him to our ER at 2 a.m.? Seriously? Because his throat was a little scratchy? Without any other symptoms? Nothing else? At least throw me a bone, buddy, and tell me it's hard to talk, hard to breathe, or hard to swallow. Or that you vomited all over your Lazy-Boy. Something? Anything?

"Nope," he said, "I feel great. In fact, I felt good even before the ambulance got there."

I gave him a glass of water and he chugged it in one gulp. No problem. I listened to his heart and lungs. Unremarkably clear. I felt his throat. No abnormalities. I examined his mouth and throat to the nth degree. Stable.

I'm not sure if I was just wiped-out at the end of my shift or subconsciously, somewhere deep inside, I disliked this patient for using my beloved saltine as an excuse to waste our time and resources. Unfortunately, he continued to build on my shaky foundation of frustrations.

"Hey, Doc," he said, "do you have anything to eat?"

Are you kidding me? "Yeah, buddy," I imagined myself saying, "we have some saltine crackers. Give me a second and I'll run to get you some."

Of course, I didn't really get him crackers. Or food. What I did get for him, though, were his discharge papers.

"Wait a second," he said, after I explained the obvious to him, that he was stable and really should have thought twice about using an ambulance for his transport in, "how am I going to get back home?"

"Pardon me?" I asked.

"A ride home," he answered, sarcastically, "or don't you guys do that anymore?"

"Listen, buddy," I said, getting my vocal wheels rolling, "you'll need to find your own ride. If you can't, you're welcome to wait it out in our waiting room. I'm not going to approve a transport ride, though, for you. You ate a saltine cracker and your throat got a little scratchy. End of story."

Then he made the ultimate statement. "Obviously, you have never eaten a saltine cracker. If you had, you'd know how much damage it can do back there in your throat."

Oh yeah? Is that right? I was just about to launch into my whole childhood obsession with saltines, how I knocked on all our neighbors' doors, when I realized what a waste of his time and mine that would be.

"You're right, sir," I answered instead, crossing my fingers, "I've never had a saltine cracker. Probably never will, either. I like candy."

As always, big thanks for reading. Next post will be Wednesday, February 17. See you then.

"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...

Medgadget Medical Weblog Awards

Vote for StorytellERdoc in both categories!

Voting ends Sunday, February 14, Midnight.

What's Your Age?

I've never been to a carnival where I haven't stopped to watch that amazingly talented man who guesses a person's age or weight. How does he do it? And where the heck does someone learn that talent? How can he possibly come within five pounds of guessing that woman's weight, the one with knee dimples, chubby pinky fingers and five chins?

I don't give myself much credence for estimating a patient's weight. The margin of error is too big for my comfort. A patient's age, though? One through a hundred? Bring it on! One paramount rule must be followed, however, if you are going to partake. You must underestimate their age by five years of what you really think. Trust me, that rule saves a lot of hurt feelings.

By far, the hardest population for me to guess accurately is the older woman who looks years younger than her stated age. All natural. No surgery. And just a few shifts ago, I was surprised, once again, by yet another of these youthful patients.

I walked into a room to treat one Mrs. Smith. She was in our ER for a minor illness and, prior to going into her treatment room, I was able to review her chief complaint as well as her demographics. Her age was listed at 74.

I clearly walked into the wrong room. The room I walked into had a woman lying in the cot who was, at most, 50 and not a day older.

"I'm sorry, maam," I said, "I must have the wrong room. Have a nice day."

I walked back to my computer and rechecked Mrs. Smith's room number. What? I was in the right room after all? Impossible!

I walked back into Mrs. Smith's room. "Maam," I said, somewhat confused, "are you Mrs. Smith?"

"That would be me," she said, sharing her big smile with me. Real teeth and all.

I decided to have some fun with her. "Are you sure, maam? Because the person I am supposed to be treating is 74. May I take a look at your wristband?"

Mrs. Smith giggled like a six year-old school-girl as she held out her left wrist. Yes, this was the real Mrs. Smith. "Wow," I continued, "I'm sure you hear it all the time, but I have to tell you--you look wonderful! I would have never come close to guessing your age."

Mrs. Smith, in her girlish way, added a blush to her giggling. I didn't care, though, she deserved to hear how good she looked. She obviously did something right in her self-preservation, and I wanted to know what her secret was.

"Honey," she said, pondering my question, "I think it would have to be the fact that I've never used soap on my face before. Well, that," she continued, now wistful, "and having a good man by my side for 50 years."

It turns out that her husband died just a year ago. And suddenly, through her sadness, she looked much older.

Just like with Mrs. Smith, though, I am always excited to meet a patient who looks much younger than their stated age. Good for them! When I eagerly ask them what their secret is, how the heck they stay so young-looking, I tend to get one of five following answers:

1) "No soap has ever touched my face" or "I only wash my face with water."
2) "Genetics--you should have seen my parents."
3) "I drink a lot of water."
4) "I stay out of the sun."
5) "I use moisturizing lotion on my face every day."

Of all the moisturizers, the most commonly mentioned is Oil-of-Olay (sorry Ponds and Vaseline). A few years ago, in one of my health magazines, I read a letter of testament to the editor from a seventy year-old guy who, thanks to his daily use of Oil-of-Olay, claimed that he looked like a forty year-old. And, one of our nurses, Sue, tells the story of treating an eighty year-old woman who, she swears, looked like a forty year-old hottie, her skin smooth and clear, glowing and wrinkle-free. Her secret, Sue said, was Oil-of-Olay.

"But," Sue continued, lowering her voice to deliver some obvious bad news, "this woman was wearing a scarf around her head, tied under her chin, and I asked her to take it off. Well, let me tell you, this woman definitely had an eighty year-old neck, wrinkled and loose. She was embarrassed by her neck and told me that she had never put cream on it. It was terrible!"

"What did you say to her?" I asked.

"I told her, 'Yeah, honey, maybe you should have put some cream on your neck.'" I loved Sue's honesty. "I'm not kidding, though," Sue finished, "it was unsightly. I don't think that woman could go anywhere without her scarf. I know I sure wouldn't." Careful, Sue (who in her own right looked fantastic), I think I see your cat claws coming out. Meow!

Well, after seeing Mrs. Smith and hearing Sue's story, I reviewed my own chances for aging gracefully. Let's see, I have good genetics (thanks Mom and Dad!). Check. I drink a lot of water. Check. Unfortunately, my face and soap are intimately familiar with one another, so that was out. And, I love the feel of the sun on my face. Stike two.

Which left me one last thing. After that shift ended, on my drive home, I swung my car into Walmart's parking lot. Stay out of my way, people, I was on a mission. I walked into the store and quickly found the cosmetic aisle. Glancing around to make sure I didn't know anybody (since real men don't wear face lotion), I knelt down and grabbed two bottles of the liquid gold everybody had been touting. "Um, it's for my wife," I stammered to the cashier as I checked out. She couldn't have cared less. If I had known she would be this apathetic, I would have bought my wife a box of tampons. And the bulk package of toilet paper, too.

Since purchasing the lotion, I have been using it religiously, every morning without fail. And guess what? After a few months, I must admit that I am probably the best-looking 84 year-old you will ever see. Unfortunately, I'm only 42.

Maybe someday I'll head back to the carnival, pay the guessing-guy my $5, and win me a stuffed animal. Or, maybe not...maybe I'll just use my Oil-of-Olay money to buy one at Walmart. That would be much easier.

What's your secret? As always, big thanks for reading. Next post will be Friday, February 12.

Medgadget Medical Weblog Awards
Vote for StorytellERdoc in both categories!

The First Time

Many of us in medicine are fortunate to treat and guide a patient through "the first time" they have a medical emergency or newly diagnosed illness. Of course, sometimes we are skeptical about that "first time" line, but more often than not my experiences have lead me to believe that the patient is telling the truth. At least in his own mind.

"I've never had a drink before tonight." (Say that with a slur, by the way.)
"Honestly, doctor, I thought the pills were Tylenol. I've never used Vicodin before."
"What? I don't know how that cucumber got up my ass! This is a first for me!
"I can't remember ever having burning like this."

You get the picture. So when a nurse ran up to me with an EKG that showed some serious abnormalities, I quickly followed her to the patient.

Surprise! I walked into a room that contained an anxious but very polished thirty-something female. She was dressed to-the-hilt in designer clothes, her make-up refined and her hair perfectly coiffed and colored. She couldn't be the owner of this EKG!

I looked at the nurse with a questioning face and she nodded her assurance to me.

I turned to the patient and introduced myself. "Maam," I said, "what brought you to our ER tonight?"

"I...am having...a hard time breathing," the patient spoke, clutching her chest, "and my heart feels funny." I could smell the hint of alcohol when she talked, her sophistication taking a few steps back.

"Do you have any palpitations with your difficulty breathing?" I asked. She nodded yes. "Any previous heart or breathing problems?" This time, a no nod. "Any recent cough or cold symptoms?" No. "Any trauma, leg or calf pain?" Another no.

"Doctor," she said, gasping for air between her words, "I have to be honest. I tried cocaine for the first time tonight and this started right after. Does this happen to everyone?"

I should have known. This was a woman who didn't smoke, didn't have any family history of heart disease, and had no past medical history of hypertension, high cholesterol, or diabetes. No serious cardiac risk factors. In other words, healthy. Except, and this is a HUGE except, she chose to use crack cocaine. Disappointing, for sure. I could only hope that she was being honest with me, because if she was a regular user and not a first-timer, her heart could have already had significant damage before presenting tonight.

"Am I going to be alright, Doctor?"

"Maam," I said, pulling out her EKG to review it with her. "I think you should know that your EKG is showing some serious findings. It looks like your heart is straining to the point where you are having a heart attack."

"Me? A heart attack? No!" She looked at me incredulously. "Are you being serious? I'm only thirty-two." I nodded my head up and down. "Yes, I am being serious, unfortunately." There was no sugar-coating this.

The patient looked at her friend sitting in the corner who, up until now, had been very inconspicuous. "Laura, you better call Larry and tell him to get here right away. And don't tell him a thing. Just tell him I'll explain everything when he gets here." Laura stood up and wiped her nose with a tissue before giving the patient a hug. She walked out of the room with her cell-phone. I hoped we wouldn't be seeing her for treatment in a bit, too.

"Is Larry your husband?" I asked when we were alone. "Yes, he is," the patient said, "and I don't want him to know I used cocaine, okay?" I assured her that wouldn't be a problem. Well, not my problem, anyway. She could tell him as much or as little as she chose. I just had a gut feeling, though, that by this end of this day, Larry would be pissed at his wife.

"But I still don't know how this could have happened," she said. I explained to her how cocaine causes vasoconstriction, or simply spasming and tightening down, of the arteries that supply oxygenated blood to the heart muscle. If the heart muscle does not get enough oxygenated blood, then, damage can occur. If the patient is a first-time user, as this woman claimed, it's not unusual to get symptoms within three hours of use. If a patient has abused cocaine indefinitely, silent heart damage may have already occurred. In which case, she could be in very serious danger.

I explained to her what was going to happen next. "We are going to give you some aspirin and some valium, but we need to avoid a few other medications that we would normally use to treat chest pain." Cocaine changed those rules. "Also," I continued, "I want you to know that a cardiologist has been called and is going to be here shortly, to take you to the cath lab."

She just shook her head and trembled. "I know," I said, holding her hand, "it's hard to believe that cocaine can do all this."

She started crying as the nurse began pushing medications into her IV. Her vitals, thankfully, remained stable.

"I have three small kids at home," she said, shaking her head. "What was I possibly thinking?"

I could only imagine what her life would be like after we got her through this crisis. If she survived this crisis, that is. Her family would face some serious consequences for her decision-making.

I explained to her that it was very important we know if she had used cocaine in her past or, as she said, this was truly a first time for her.

"Yes," she assured me, "it was my first time. I mean, look at me. Do I look like someone who used cocaine before?"

I bit my tongue on her question. In reality, yes. She did look like someone who may have used cocaine before. Cocaine has no "look," really. Well, not clothes-wise or status-wise. But it does have a look of desperation when things go wrong, and this patient sure had that "look" now.

We got this patient to the cath lab. Luckily, she had no significant blockages and, more importantly, the medications we had given her in the ER had begun reversing the vasoconstriction before permanent damage occurred. She was going to be alright.

After his wife's successful catheterization, Larry, her husband, came down to the ER carrying a large cookie tray to thank our staff. Yes, he matched his wife's look--a pressed shirt and tie, penny-loafers, and wavy undisturbed hair. With a hint of alcohol on his breath. "I just don't understand how this could happen, though. She's too young and healthy to have had a heart attack."

I just nodded at his words, the silence floating between us like a concrete barrier. I was bound by patient confidentiality from sharing with Larry the truth of his wife's situation and, besides, it wasn't my place to tell him of her cocaine use. Instead, I diverted him and asked about the weather outside.

We shook hands and I told him to share our best wishes with his wife during her recovery. As he walked away from me, I couldn't help but think of their marriage and their three kids. Silently, I prayed that things would turn out okay for this young family.

Another "first" patient, she turned out to be. I thought back to her words. "Doctor, I have to be honest. I tried cocaine for the first time tonight and this started right after." Was it really her first time using? I hoped so, but I've been fooled before.

I can only hope, though, for her sake that this "first" will be her last.

As always, I thank you for reading. The next post will be Wednesday, February 10th. Until then, I hope you have a good start to the week. If you didn't vote yet, please do! This is the final week. I appreciate your support.

Medgadget Medical Weblog Awards

Vote for StorytellERdoc in both categories!