Emergency! (26 page)

T
HORACOTOMY
: A procedure in which the chest is cut open.

T
HREE
H
OTS AND A
C
OT
: Three meals and a bed—what homeless patients seek when they show up in the ER with a bogus complaint like, “Every time the train goes by, my feet get numb.”

T
OON
: A loony-toon; a crazy; a mental health patient.

T
RAIN
W
RECK
: A patient with severe, complicated multisystem disease or injury.

T
REAT
'E
M AND
S
TREET
'E
M
: Rapid turnaround time in the ER.

T
RIAGE
: To sort out according to severity of illness or injury, so that the more critically ill or injured patients are treated first. This runs contrary to our social custom of first come, first served, and can create resentment in the waiting room.

T
ROLL
: A patient found under a bridge, smelling of alcohol, without a history or name.

T
ROLL THE
L
ABS
: To order a broad set of labs in an attempt to fish for a diagnosis in a
GOMER
who looks
SICK
but can't communicate.
See also
GOMERGRAM
.

T
ROLLS
N
EVER
D
IE
: A corollary of Murphy's Law that suggests that terrible people cannot succeed in destroying themselves however hard they try. Evidenced by the inevitable survival of the drunk driver who wipes out an entire family on their way home from Sunday morning services. It is the inverse of nice people getting cancer.

T
UBED
: Intubated.

VF
IB
: Ventricular fibrillation—a life-threatening state in which the heart quivers instead of beats. The cure is to
DEFIBRILLATE
or
SHOCK
the patient.

VT
ACH
: Ventricular tachycardia. A rapid heart rate originating abnormally from the ventricle. Often a sign of impending
VFIB
or
CARDIAC ARREST
.

WNL: Within normal limits. Often written as a summary for some part of the physical exam, but often sarcastically interpreted as We Never Looked.

Special thanks to those who contributed to this section: Milton H. Anderson, Eve Boyd, Keith N. Byler, Bill Davis, John Dente, Edward Dickinson, Gary M. Flashner, Corky Gordon, Donald Graham, Mike Greenberg, Charles Hagen, Hugh F. Hill, Philip Levin, Thomas J. Motycka, Scott Oslund, Gregory D. Post, Campion E. Quinn, Sylvia Sydow
.

M
y thanks to Anita Jones. She is my editor, consultant, writer, rewriter, and friend.

Thanks also to Frances Hall and Dartmouth Medical School. My father, the dusty professor, and his friend Nano kept me on track. Joe Bell and Sherry Angel put lots of red pencil to the stories. Readers and advisers included Steven Smith, Howard and Françoise Appel, Eve Boyd, Carol Castro, Phyllis Contini, Spencer Downing, Corky Gordon, Craig McIntyre, Barney Shapiro, Carolyn Sindell, Joe Veit, Jon Wild, and the Great Hansens: Raymond, Greg, and Theresa. Michael Eliasberg kept the lawyers at bay. Susan Sherba took care of all the paperwork. Jane Sindell and Matthew Snyder opened the door, and Andrew Blauner, Kim Witherspoon, and Craig Nelson liked the book and made me feel welcome. Special thanks to Theresa for being my companion and to Griffin for being my son.

And thank you to the hundreds of other writers who took the time to send me their stories from the Pit. It was my pleasure to read them and my regret to have been unable to use more of them.

Mark W. Brown grew up in Montana. He graduated from Harvard Law School in 1970 and practiced law in Los Angeles for nine years. In 1982, he graduated from Dartmouth Medical School, and he has practiced emergency medicine ever since.