“Hi Mr. Gacy, I’m Dr. Gray. That’s a very interesting Charles Manson T-shirt you’re wearing! Who would have guessed that chainsaws could be so versatile? So, how can I help you today?”
“I need prescriptions for OxyContin, Talwin and Ritalin. And something for my nerves, too. And my parole officer says I have to get these disability pension forms filled out right away… .”
¡Ay, caramba!
My fourth patient presents with a stellate scalp laceration sustained in a booze-induced inward pike off the back of a moving pickup that occurred sometime around midnight. I'm surprised he waited so long to come in - it looks like an asteroid collided with the back of his skull. I give him a complimentary reverse yarmulke and get busy with my needle driver and forceps. While I sew him up we listen to the not-so-soothing strains of Rocky repeatedly breaking the 11th Commandment (Thou Shalt Not Upchuck on the Floor of the ER). Half an hour later my crash test dummy is looking human once again. Antibiotic dressings, a tetanus shot and a trip to the radiology suite follow in short order. Not long after that he's exiting stage left. Goodbye Mr. Bloody-Head! No more Olympic asphalt-diving, please! I catch up on my charting and order some IV Maxeran for Rocky.
The receptionist drops another fresh batch of outpatient charts on the ER desk and whispers, “Incoming!” That immediately triggers a harrowing flashback to the time I travelled up the Nung River deep into the heart of Cambodia in search of a brilliant yet almost certainly insane colonel who…wait a minute - that was Benjamin Willard, not me. Oops. Sorry about that, folks. Anyhow, the triage note on patient number five reveals he’s here today because for the past few months he “just hasn’t been feeling quite himself.” I know from previous ER encounters that he has a tendency to ramble. This time I’ll try to take control of the interview by avoiding open-ended questions.
“Mr. Filibuster, I’m going to ask you a series of questions and I’d like you to just answer yes or no, okay?”
“Okay, doc.”
“Have you lost any weight recently?”
“When I was a young ‘un living down in Oklahoma back in the Dirty Thirties… .”
Can I get a swig of that grape Kool-Aid?
Patient number six:
“Hi, I’m Dr. Gray. How can I help you today?”
“I’m from out of province and I’ve run out of my birth control pills. Can you give me a refill?”
“No problem. What are they?”
“I’m not sure. Something-21.”
“Most of the brands come in packs of either 21 or 28.”
“Actually, it might have been Something-28.”
Swing low, sweet chariot… .
Patient number seven is another prescription refill. The last one was a bit of a gong show, but I’m confident things will go more smoothly this time.
“I’m Dr. Gray. How can I help you?”
"I’m here in Ontario on vacation and I’ve run out of my pills. Can I get some refills?"
“Sure. What medications do you take?”
“I don’t know the names.”
“Did you bring your bottles with you?”
“No, but I can tell you what the pills look like. There’s four white ones, a pink one and a wee little yellow one.”
Just take me now, Lord… .
Despite having an entire pharmacopoeia at my disposal, Wookiee-like noises continue to emanate from Rocky’s cubicle. Eventually I throw in the towel and admit him to the medical ward. The rest of the morning continues on in a similar vein. The afternoon’s no prize, either. Around suppertime the nurse supervisor informs me the waiting room is finally empty. Thank God! I was about to change my name to Sisyphus. If I’m lucky, things will stay quiet for a little while. I go home to eat with Jan.
By the way, we never say the Q-word out loud in our department. Every ER worker on the planet knows the instant you make a comment about how quiet it is, a jumbo jet full of ventilated preemies will crash land in your staff parking lot. Probably right on top of your car. That’s just the way ER karma rolls.
It is now the witching hour. I’m two-thirds of the way through my 24-hour shift. I think I’ve treated close to 20 people since I got back at 8:00 p.m. Thankfully, I’m down to the last one. According to the triage note, she’s a previously healthy 60-year-old who has been experiencing minor cold symptoms for a week. Her vital signs are all normal. Hmm. Something tells me this case isn't going to make it onto House. Oh, well. One last person to see, and then I get to crawl into bed for a while.
“Hello, Mrs. Coryza, I’m Dr. Gray. How can I help you tonight?”
“Well, I’ve had this runny nose and cough for a week now, so I figured I should come in and get checked.”
“Have you had any fever?”
“No.”
“Have you been short of breath?”
“No.”
“Are you coughing up any sputum?”
“No.”
“Any other symptoms?”
“No.”
“What made you decide to come in tonight?”
“I just thought it was about time I got some penicillin for it.”
Her examination is completely benign. Since I know what she is expecting from this visit, I carefully explain to her why using antibiotics to treat viral upper respiratory tract infections is not appropriate.
She takes a moment to mull it over, then adroitly changes her tack.
“Can I have a chest x-ray, then?”
She doesn’t need that either, but since she obviously has no intention of leaving this department empty-handed, it’s a compromise I can live with. I write up the requisition.
“The x-ray department’s closed now. Come back on Monday morning and they’ll do it then.”
As I turn to leave she says: “You know, my son should probably see you, too.”
I’m crestfallen. More business. Precisely what I do not need at this hour of the night. I don’t recall seeing anyone else in the waiting room, though.
“Where is he?”
“At home. Can you stay here while I go and get him?”
“Well, that depends. What’s wrong with him?”
“He was in a car accident.”
“A car accident? What time did it occur?”
Oh, it didn’t happen today; it was about a month ago.”
“A month ago?”
Yes. His chiropractor says he’s got whiplash, but I think we should get another opinion.”
“You want a second opinion on a Saturday at midnight?”
“Yes, I’m wondering if maybe he should be getting some other type of treatment.”
There are a number of ways I could respond to this request, but most of them would probably earn me a stern reprimand from the College of Physicians and Surgeons.
“Why don’t you bring him in on Monday morning when you come for your chest x-ray?” I suggest sweetly.
“Will you be here Monday?” she asks.
“Yes.”
“Okay, that sounds good! Good night, doctor. By the way, you should try to get more sleep – you look really tired!”
It’s Got to Be in Here Somewhere
Recently a middle-aged woman took a tumble while jogging on a dirt road. She fell with her arms extended, so her palms and wrists took the brunt of the impact. In ER lingo that mechanism of injury is known as FOOSH, or “fall on outstretched hand.” Hey, don’t look at me – I’m not the one who comes up with these half-baked acronyms. Anyway, after going home and removing as much of the gravel from her wounds as she could, she presented to our emergency department. Once I was satisfied there were no other significant injuries I applied a topical anaesthetic gel to her abrasions and scrubbed all the dirt out.
“How’s that?” I asked her when I was finished.
“Much better, although it feels like there might still be something in here,” she said, pointing to the middle of her left palm.
“Okay, I’ll send you over for an x-ray.”
Fifteen minutes later I went to the radiology department to look at her films. To my chagrin, there was a pebble-sized object in the centre of her left hand. It appeared to be right on the surface of the skin. How the dickens could I have missed such an obvious foreign body? I returned to the ER with the x-rays and carefully reassessed her hand, but I couldn’t find the offending piece of gravel. After a brief discussion we decided our only option was to go in and retrieve it.