Emergency! (16 page)

“Come in, come in, what can I do for you?” I opened a door to the treatment area.

“Do you have a few minutes? In private? I don't want to hold you if you've got someone you have to see.” I looked at the names on the board and fought the urge to be truthful.

“Should I come back later?”

I motioned her into a room. She closed the door, but sat next to it. I sat facing her. She leaned forward and stared at me with a dazed look and began to smile somewhat vacantly.

“I've got a question for you that I've never asked anyone before,” she said. I leaned forward. “Are you involved?”

“Yes,” I lied. The silence became uncomfortable. “I'm married.”

“I was going to ask if you'd like to go with me to the symphony tomorrow. Would you like to go anyway?”

“Are you the one who called last night?”

“Yes.” She looked downward, but for only a moment.

“Would you keep this confidential?” She reached into her backpack and produced an envelope addressed to me, only with my name spelled phonetically. “I'd like it back when you've read it.”

The handwriting was minuscule and the lines overlapped, but it was impossible to ignore the seductiveness of phrases such as “I want to be your lover.… You are so compassionate and understanding.…” It went on and on. I felt uncomfortable to be reading it.

She was smiling and looking at me. She brushed back her hair in a coquettish way. She was very attractive. She was waiting for an answer, but I could not translate my feelings into words. For a moment, it was tempting. Then I thought, that's all I need right now is an affair with a married medical student who is pregnant. Then I recalled what she said the night before—with HIV.

“Was that true what you said about being HIV positive and a medical student and being pregnant and bleeding?” I sort of blurted it out.

“I wish it wasn't,” she said. Then I noticed that her hands were scarred, like I had seen in crisis patients who must physically abuse themselves to “let out the tension.”

“I just need a friend right now,” she said plaintively. She began moving toward me.

I doubted that friendship was all she wanted. “I don't feel worthy of your affection or competent to counsel you. Would you stay and speak with someone who's trained in how to approach problems like yours?”

With a feline movement, her hand was on the doorknob. “I can't stay, but I'll leave you messages about how I'm doing.” In a flash of pale green, she was gone.

I felt dazed and sad. I was drawn to her and felt that I'd blown it by
being professional when she wanted a friend, by thinking of her as a patient rather than as a woman. Suddenly I wanted to find her again, to tell her that I cared and wanted to go out with her. The dean's office would have her picture and from that I could get her name and telephone number. If I did, I knew that my personal involvement with her would not stop at having dinner or attending the symphony. Why was the thought of pleasing her as a man so exciting? Was it the poignancy of loving someone doomed to a premature, unnatural death?

I never found out who she was. She never left any messages. But I saw her again, two years later, in the reception area for lawyers' offices. I was reading the newspaper while a contract was being reviewed when I heard a soft, whispering voice.

“Is anyone sitting there?” She indicated the chair next to mine. I motioned for her to sit, but was not able to place her for a few minutes. Her hair was drawn in a bun. She was wearing a gold necklace, white blouse, and dark slacks. She was still as attractive as when I saw her in scrubs, but looked less tentative, more self-assured and purposeful. She returned my look without emotion.

“Do you remember me?” I asked. “We spoke on the telephone, then met in the emergency room.” Her cheeks began to flush in recall.

“Well, how are you?” I asked.

She told me she was suing someone. At that moment, the receptionist announced that she could go in to see her attorney.

I have never seen her again, and never discovered whom she was suing. Maybe her husband, for giving her AIDS. She no longer looked vulnerable or afraid, perhaps because she and a lawyer were representing her interests. I felt simultaneously satisfied that she had become empowered, and sad that she had left me out of her life.

From that one early morning telephone call, I will always regret that one woman would not let me be her doctor and that I could not let myself be her friend.

ROBERT D. HERR, M.D.

Salt Lake City, Utah

T
urf: to transfer to another facility a troublesome patient.

One quickly learns how to “turf” in the ER. A gentleman in his seventies was brought in by his wife for worsening leg edema. The patient also suffered from organic brain syndrome (Alzheimer's), making it difficult to obtain any history. The wife kept insisting that the patient was a World War II veteran and he should be transferred to the VA hospital. We called the VA and informed them that we would be transferring this patient. One of my colleagues decided to cement the transfer by placing a sign around the patient's neck stating that he was a World War II veteran. We congratulated one another for successfully turfing the patient.

Toward the end of the shift, we saw our patient “bounce back” to the ER. He still had the sign around his neck, but there was a different message. It now read:
NICE TRY. RIGHT WAR, WRONG SIDE
! Upon further questioning of the wife, we found out that the patient had fought on the side of the Germans.

DAVID B. LEVY, D.O.
         

Pittsburgh, Pennsylvania

O
n a quiet evening in our Emergency Department, the ambulance radio crackled to life: “This is Ellwood unit nine-five en route to your location. We have an eleven-year-old male with an awl attached to his arm.” Thinking some type of tool had penetrated the boy's arm, I nonetheless asked them to repeat, as the story sounded peculiar. I asked if they had said “awl” or “owl,” and much to my amazement came the reply, “Owl. O-w-l!”

Two minutes later, the crew wheeled in a frightened young boy with a live young screech owl perched on his forearm, talons clamped firmly, and looking as petrified as the boy. Initial attempts to simply lift it off resulted in the owl tightening its grip and the boy screaming in pain. I not only was trying to separate the two, but hoped to prevent the comic nightmare of an owl flying free in our ER. Finally, while an assistant held the bird's body and wings, I was able to unfurl the talons using a hemostat. My assistant had to grab each talon as it was released to prevent the owl from latching back on. The boy had only a few superficial puncture wounds, and the bird was unharmed.

The owl was returned to the original scene by the ambulance crew and set free. The boy was also set free, and as he skipped off into the night was heard to exclaim, “Owl's well that ends well.”

DAVID J. SIMON, M.D.
      

Pittsburgh, Pennsylvania

T
he Angel and I are close acquaintances—perhaps friends, or even colleagues. We work at cross-purposes. We each have a job to do. With fifty years of contact—thirty years in the Army and twenty in the Pit—we have been involved together in more cases than I care to count. Ultimately, the Angel wins, but until the clock stops for the final score, I am willing to contend with him. Once, I beat him out of a sure thing by making him laugh.

One night in the Pit, things settled down to almost nothing at about 0300, and I went outside to stretch and smoke a cigar. Up drove an aging and worn Volvo. A woman—young but also worn—was lying in the reclining front passenger seat. She answered my question readily enough: “Vaginal bleeding.” As I pulled the seat erect to help her out, she went unconscious—now that's orthostatic hypotension with a vengeance. I got her into a wheelchair and rolled her in with what the Supreme Court once described as “deliberate speed” so as not to alarm her husband any more than necessary. I slowed down at the nurses' desk to announce, “I'm putting this vaginal bleed into room sixteen. Call GYN stat.” Rooms 5 and 6 are the GYN rooms, room 16 is the resuscitation suite. My resident got the clue and was on my heels when we entered. She took a quick look and said, “Her pad is not soaked through, but you said she was bleeding like a stuck hog?”

“No, I said she is breathing like a stuck hog.”

When it comes time to butcher hogs, you cut both carotid arteries, and they do bleed a lot, but in a few seconds unconsciousness takes
over and they quit struggling. Until they die, though, they point their noses up to fight for air, because they have too little blood left to carry oxygen. The resident got the picture immediately, and did a fine job of resuscitation. GYN did respond stat. She was in the OR within minutes.

I knew they would save her, for when I made the remark “breathing like a stuck hog,” I heard a soft chuckle, felt a little swish of air, and got a whiff of sweat and feathers as the Angel turned and left.

DOUGLAS LINDSEY, M.D.

Tucson, Arizona
         

O
ne of the nurses who was picking up dirty linen noticed a pink wad of gum on a bedside table. She grabbed a paper towel, picked up the disgusting thing, and threw it in the trash. When the patient returned to his room from X-ray, he asked, “Has anyone seen my Miracle Ear?”

MYKA CLARK, R.N.
       

Green Bay, Wisconsin

N
ot everyone reacts to pelvic exams in the same manner. I've noticed that many women tune out conversations or questions until the exam is over. In one such case, while the patient was in stirrups, the physician asked, “Are you sexually active with more than one partner?” The patient was staring at the wall, seemingly oblivious to the question. I was the nurse assisting the exam, and I touched her shoulder to bring her back to the conversation. She looked startled and said, “Oh, I thought he was talking to you.”

BRENDA HILL, R.N.
    

Syracuse, New York

P
rior to going to medical school I worked as a paramedic. We were dispatched one Saturday afternoon to a woman with a reported miscarriage. Upon arrival, we found the fire department EMTs already on the scene. They reported that the woman had induced
an abortion with a coat hanger, and that the fetal remains were in the corner, covered with a towel. The woman was in shock, with a rapid heartbeat and marked hypotension as well as active vaginal bleeding. We followed trauma protocol and transported her to the local Catholic hospital, where she was taken immediately to the operating room for repair of massive vaginal lacerations. The EMTs had wrapped the aborted fetus in blue pads and brought that to the hospital as well.

As we were completing our paperwork, the hospital's priest came into the ER. He went to the dirty utility room where the wrapped fetus had been placed. The priest baptized the fetus, anointing the blood-soaked towels with holy water, and then withdrew, leaving the charge nurse to handle the remains. The nurse put on gloves and, with a grim expression and a large pathology specimen-bucket, went into the dirty utility room. She carefully unwrapped the towel and blue pads from around the fetus, and paused. We watched her carefully inspect the specimen. She called a colleague in for consultation. Their examination was followed by an intense, low-voiced conversation. Finally, the nurse came to us and reported that what the woman had removed from her vagina with a coat hanger was, in fact, a swollen tampon.

To this day, the thought of a priest administering the ritual of baptism to a tampon never fails to bring a smile to my face.

EDWARD T. DICKINSON, M.D.

Menands, New York