Emergency! (18 page)

Many people like this come to the ER in the cold weather. Hoping
to avoid the homeless shelter, they present themselves with some complaint that they hope will rate an admission. Some are quite adept at malingering, and know just what to say to gain a night in the hospital. Some favorites are, “I have crushing chest pain.” Or, “I can't see out of my right eye.” And, “I have kidney stones.” These require CT scans, IVPs, and a host of other expensive tests, not to mention physician and nurse time. There is no disincentive for them when they come to the ER. Some of them will try several times a night in different hospitals or on different shifts in the same hospital. This allows them to work on their story, hoping that a new complaint will be the open sesame to a warm hospital bed and free meals. They know that once in the hospital it is difficult to get thrown out, with the Patient's Bill of Rights posted everywhere and the Patient's Rights Advocates ready to do battle against staff who have the temerity to try and discharge someone just because he doesn't have a medical problem.

Actually, I'm getting well acquainted with all the residents of Penn Station. After I've Kwelled them for lice, sutured their head cuts, pumped their stomachs, etc., we meet several hours later in the station when they ask me for “a dolla.” When I remind them I'm the doctor who just treated them for free, they say, “Oh, how about five dolla.”

Just before I left to go home tonight there was a shoot-out in Chinatown that kept me overtime. Apparently a gang-related incident. The paramedics told me they had to step over many bodies to get to the people who were screaming. One member of a rival gang had entered a disco and shot an Uzi into the crowd in hopes that one of the bullets would find an opposing gang member. Three were DOA. One head injury died in the OR. Two chest wounds and several minor extremity wounds did OK. The police arrived in force with radios going and pads and pens out. As usual, they asked for my name but wouldn't tell me why. They always take control of all the phones and desk space in the ER, which makes it impossible to do any work.

I received a response to my inquiry about the Royal Flying Doctor Service. They said I would first have to register with the Australian
Medical Service. I discovered they are completely funded by charity, so the rumor of big bucks is groundless. I don't know how I'd do in the air. I'd be permanently on Dramamine, I'm afraid. Anyway, Cathy and I are becoming more intertwined, so Australia doesn't look as inviting.

Write soon,

Campion

Dear Larry,

Yesterday while working in the ER, I had the pleasure of dabbling in another related field: the fascinating world of dentistry. Mr. Rangoon, formerly a native of Sri Lanka, now a denizen of Washington Square Park, came into the Emergency Room with the right side of his face quite swollen. Being an astute physician, I was aware of some indisputable facts. He was poor, uneducated, hungry, and unwashed. His long shaggy hair was the home to an entire civilization of lice, and his veins were thrumming with alcohol and cocaine. He had the wild-eyed stare of those wakened suddenly from a sound sleep. A few sentences of garbled communication, and all my suppositions were confirmed. His breath was truly fetid. In the past I have not flinched at the rancid odor of tampons lost for months in cavernous vaginas (toxic box syndrome). I have confronted rotting feet of the homeless that have not seen the sunshine (let alone soap and water) for years (toxic sock syndrome). But just talking to him in an enclosed space brought tears to my eyes. He was febrile and perspiring like the proverbial pig. He looked sick and was in pain. He admitted that the cocaine was wearing off, and he no longer had the resources to replenish his supply. My empathy threatened to increase my flow of tears.

As he spoke in his interesting version of pidgin English and home-boy argot, my attention was drawn to his mouth. His teeth were cracked and yellow-brown, and looked like rotting wharf wood. They
moved in their sockets as he spoke, to and fro with every breath or movement of the tongue. I told him to sit down. There were no empty chairs, so he sat on top of the garbage can. I put on a pair of latex gloves and examined his mouth with a flashlight. It was a sight to give a periodontist nightmares. His teeth (such as they were) were surrounded with angry red mounds of gum tissue, each mound issuing gouts of green pus with little or no provocation. This sight, added to the overpowering stench, nearly had me running to the bathroom.

I wondered: His teeth look so loose, will they come out if I give them some encouragement? Ever the intrepid doctor, I looked at my gloved hand, considered the mess that was his mouth, and put on another glove. I asked him to open his mouth and told him not to bite. I promised myself that I would stop if he started to scream (or I started to scream) and call a dentist. (Though I knew of no dentist who was likely to leave his lucrative practice to rush over here and look at this mess.) I thrust my hand into his festering maw and firmly grasped his remaining front teeth. I could feel how loose they were, though they felt like they were connected with string. I gave a solid, confident yank, and out came three teeth with several cupfuls of pus and blood. Boy, was that satisfying! His facial swelling was going down already. Mr. Rangoon sat calmly, seeming to take all this with equanimity. Encouraged by his lack of objection, I continued to pull the remaining teeth from his head. They all came out with little problem except for one stubborn molar in the top back. I looked around the ER for something like a set of pliers that I could use to remove it, but in a rare lucid moment, I stopped to think, and changed my mind.

I looked at Mr. Rangoon and realized suddenly that untoothing him might be cause for some concern. He was sitting on the garbage can, drooling blood and pus. His chin was much closer to his nose, and he seemed to have aged thirty years in a few minutes. He really couldn't speak well at all, and when he did, the garbled communication was accompanied by a mist of blood and saliva that was sprayed all over the room. So I didn't encourage much talking. He was a very sad sight indeed.

My anxiety level rose. Did I need a consent to do this procedure? Should I have used anesthesia? Do I need a dental license to do this? What would some ambulance-chasing lawyer say? Would he accuse me of wantonly and without regard for his smile, removing Mr. Rangoon's teeth? What would Mr. Rangoon tell his family when he went home tonight? “Honey, I went to the hospital and some young doctor took out my teeth.” I was concerned. So I did what all concerned young physicians do. I called a consult. Not just a consult, a whole mess of consults. Almost every consultant in the hospital had his beeper go off. I wheeled Mr. Rangoon into the main ER. He was covered with blood and speaking incoherently. I sent the eager residents to “work up the new trauma.” In minutes he was swarmed by white coats. He had blood tests and urine tests, chest X rays, EKGs, CT scans of the head and facial bones; he was poked, prodded, pricked, swabbed, and smeared. I did a little creative writing of my own, mentioning that I had triaged a patient who reported being beat up outside the hospital, before he passed out from acute intoxication.

Several hours later, I was still disposing of the evidence, scattering teeth in trash cans and emesis basins all around the ER. A surgical intern asked me if I had seen the “bum” with the “really messed up face” in room 3. Naturally I told him “No,” but did not give up the opportunity to remind him that “bum” is a pejorative appellation, and the preferred term is “economically challenged.” Chastened, the intern reported that the “economically challenged” individual was supposed to be an eccentric carrying a shopping bag full of money when he was robbed and beaten mercilessly by some drug dealers just outside the hospital. “Really!” I exclaimed. The intern reported that Mr. Rangoon was admitted to the neuro intensive care unit to rule out cerebral trauma. I was impressed how the story had gotten so blown out of proportion, but did a quick scan of the ER for a shopping bag just in case. This place would keep a TV show in business for years.

Cathy and I are presently considering jobs in the big sandbox, aka Saudi Arabia. We are speaking to an oil company who needs doctors and nurses to take care of their employees while they are overseas.
Our hope is to make enough in a year or two to pay off the student loans, and maybe have some left over for a down payment on a shack d'amore. We are flying out to Houston for an interview. They are putting us up in a nice hotel where we plan to start our towel-and-sheet collection, just in case the job doesn't pan out. I'll keep you abreast of any developments.

Warm regards,                          

Campion “Camel Jockey” Quinn

Dear Larry,

It started as a regular day at St. A's yesterday. The usual fun and games: drunks, crackheads, homeless, MIs, and lacerations (here they call them “lacs,” as in alas and alack.) Just your garden variety stuff.

Late in the afternoon, the nursing-home crowd started showing up. One of them was an elderly Hispanic man, Mr. Ortiz. He came via ambulance from the Bailey-Slavin Nursing Home, known colloquially as the Barely-Livin' Nursing Home. He was sent over for dehydration and sepsis, a common enough problem in his peer group. Mr. Ortiz's chart gave his main diagnosis as “severely demented” (what a surprise) and said he was a “behavior problem.” A cursory exam revealed a wasted man covered with urine and feces; bedsores gaped at his sacrum, and both his legs were red and swollen with infection. He exhibited an interesting neurological finding, a combination of echolalia and perseveration. When moving him during examinations, he shouted,
“DIOS MIO, DIOS MIO, DIOS MIO, DIOS MIO”
incessantly. After drawing blood he changed to,
“AYUDEME, AYUDEME, AYUDEME, AYUDEME, AYUDEME, AYUDEME …”
And … well, you get the idea. This shouting took on the character of Chinese water torture. Mr. Ortiz possessed a loud, clear, rather high-pitched voice, as older men sometimes do. It had a nails-on-the-chalkboard quality.

The
AYUDEME
doggerel continued for several hours. Tension was
building. It became increasingly difficult to think or talk or do anything in a nice way with the constant shouting. Finally, I walked over to the stretcher, leaned in Mr. Ortiz's ear, and shouted “SHUT YOUR FACE!” He took this lapse of mine very well and was quiet for several seconds. The silence began to settle. Everyone in the ER seemed relieved, and I was halfway back to the counter when I heard, “SHUT YOUR FACE, SHUT YOUR FACE, SHUT YOUR FACE …” This got great yuks from the worker bees. It was not long before members of the staff had Mr. Ortiz repeating their favorite expressions: EAT ME, SHITHEAD, FUCK DOCTOR—–(place the name of your favorite attending here), and the immortal FRANK BURNS EATS WORMS. Despite this feast of the intellect and flow of the soul, I was becoming unglued. It is very difficult to compose even a minor chart note while someone is shouting, “EAT ME, EAT ME, EAT ME …”

In the midst of all this din, Mr. Rios arrived. While smoking crack and drinking to excess, he had neglected to take his Dilantin. He was seizing with considerable vim and vigor, and these seizures were not responsive to my ministrations of Valium and magnesium. He eventually responded after I added a gram of phenytoin intravenously to the mixture. It was good that it worked, since he showed no signs of tiring. Mr. Rios was a stocky man whose arms were covered with homemade tattoos of snakes and skulls. His chin sported a goatee, and there was a livid scar under his right eye. Two earrings in his right ear and a “rattail” at the nape of his neck completed his fashion statement. All in all, he was the very flower of urban youth. He had no doubt lived a hard life. When he began to get agitated we gave him a little more Valium, for fear of him seizing again. He began to snore and slept peacefully, oblivious to Mr. O's vocalizations.

Several hours passed and Mr. Rios awoke suddenly and became quite demanding. He requested food, scotch, and “my fucking money.” Since there were no bank tellers or barmaids immediately available, his requests went unheeded. This did not stop him from asking for it, though. His shouting went on and on, blending with “EAT ME, EAT ME, EAT ME …” The volume in the ER was
becoming unbearable. Mr. Rios, no doubt an honors graduate of some assertiveness-training course, called out to whomever was in earshot for his food, scotch, and money. When they didn't comply he would castigate them in a ferocious manner. To a nurse, “You cunt! I'll fuck your daughters and strangle your infant sons!” To a transporter, “You faggot! You pussy! Come over here and suck my cock!” And on and on in this manner. I found it hard to relegate this to purely background noise. When Mr. Congeniality got up off his stretcher and shoved a nurse who was trying to quiet him, I was ready to do my all to shut him up. I was joined by several other members of the staff. We grabbed him and threw him onto the gurney. Our intention was to hold him there while a nurse drew up another dose of Valium to quiet him. (Although it is strictly against hospital policy to use “chemical restraints” on a patient just for the convenience of the staff.) This upset him to no end. He was mortally offended, as if we were old friends who had just betrayed him. Whatever decorum he had been observing was completely gone now. He sprang from the gurney, snarling, and tossed me into a wall. Dr. Bernstein and several other staff members entered the fray, Mr. Rios holding his own, kicking and biting anyone who came near him. I tackled him and forced him backward into a wheelchair. The security guards arrived with the leather restraints. I stood in front of the chair and pinned his arms to the chair's armrest. The guards tried to put on the restraints. Now Mr. Rios was looking directly into my face. He was struggling mightily, and was lifting me and the chair off the ground. I was terrified of his strength and what would happen if he got loose. I could smell his fetid breath as he cursed me, then he spat in my face. Just as I was thinking how disgusting this was, and how he probably had some lethal form of TB, he kicked me squarely in the testicles. I didn't think of much then at all. I was both trying to get away and yet not let go of his arms, very difficult indeed. He half stood from the chair and was trying to bite my nose when I butted his face with my forehead. He slumped down in the chair, a four-centimeter laceration across the bridge of his nose.