Using her films as a map, I infiltrated her left palm with local anaesthetic, made an incision and started looking. No mysterious particle popped into view. I did some blunt dissection. Nothing. I extended the incision radially and continued the search. Nothing but blood. Several minutes passed. Where the hell was it? Every so often my patient would ask, “Find it yet?”

“Not yet, but it’s got to be in here somewhere.”

After what seemed like an eternity, one of the x-ray techs walked into the room.

“Oh, there they are,” he said. “I’ve been looking for these films all over the place. The radiologist wants to read them before he leaves.”

“Could you please ask him if he’d mind waiting for a couple of minutes? I’m using them to help me locate this foreign body.”

“What foreign body?”

“The one in her palm,” I replied, and pointed it out on the film.

“Oh that,” he said. “Didn’t you get our last memo? We’re not using the old arrow-shaped marker to show the spot where the patient has the foreign body sensation anymore. The new marker looks just like a little pebble.”

Semantics

A while back I saw an ER patient who was complaining of a persistent cough. It appeared to be nothing more than the common cold, but because it had been going on for a few weeks I elected to send him for a chest x-ray. Once the film was processed I went over to the radiology department to look at it. It was completely normal - no pneumonia, cardiomegaly, congestive heart failure, pleural effusion, pneumothorax or anything else of significance. I went back to the patient’s cubicle to wrap up the interview.

“Well, Mr. Kowalski, I don’t see anything on your chest x-ray.”

“Nothing at all?”

“That’s right.”

“Okay. Thanks anyway, doc.”

I thought he looked at me a little strangely as he left, but I figured I was just being paranoid. I moved on to the next patient.

An hour later I was back in the radiology suite reviewing another film when one of my colleagues showed up. He pulled out the chest x-ray of the patient with the cough I had seen earlier.

“I already looked at that one,” I said. “It’s normal.”

He seemed taken aback.

“What did you say to him?” he asked.

“I told him I didn’t see anything on his x-ray.”

He started laughing.

“What’s so funny?” I asked.

“He called me at my office in a big panic saying he had just had an x-ray at the hospital but the doctor who had ordered it didn’t know how to read it.”

“What made him say that?”

“You told him when you looked at his x-ray you didn’t see anything.”

Needless to say, ever since that day I’ve changed the way I tell patients their x-rays are normal.

Rocky II (The Sequel)

It’s yet another Saturday morning and I’m back for more punishment in the ER. Where did all the people in the waiting room come from? Five minutes ago the joint was empty. Maybe spontaneous generation does exist after all.

My leadoff patient is none other than the infamous Rocky. Once again he’s toxic and on the verge of hurling. Whenever he shows up like this I usually end up admitting him for a day or two to help him dry out. Things are a little different today, though – there are only two empty beds left in the entire hospital. If I admit him to one of them I’ll be snookered if I need beds for sicker patients later on in my shift. To the best of my knowledge, Rocky has never had any potentially dangerous alcohol withdrawal problems such as the DTs or seizures. After careful consideration I make an executive decision to turf him to a detoxification centre. I ask the ER charge nurse to have switchboard locate the closest detox centre’s intake worker.

“Aren’t you forgetting something?” she asks.

“What?”

“They won’t want to take him the way he is now.”

True enough. Detox centres don’t like their alcoholics drunk and barfy; they like them dry and stable. Most of them will only take “clients” who have been alcohol-free for at least a couple of days.

“Yeah, I know that.”

“So how are you going to convince them to take him?” she persists.

“I’m going to stretch the truth a little bit.”

She looks at me askance as her index and middle fingers carve a pair of scare quotes into the air above her head.

“Stretch the truth a little bit?”

“Okay, I’m going to lie.”

Switchboard puts the call through.

“Hi, this is Luba at the Pink Elephant Detox Centre speaking. How may I help you?”

“Hi Luba, this is Dr. Gray calling from the ER. I have a patient here I’d like to transfer to your facility.”

“Certainly. What’s your client’s name?”

“Rocky Emesis.”

“ Rocky Emesis?”

“Er, yes. Are you familiar with him?”

“Extremely. When was his last drink?”

“Um… I don’t think he’s had anything so far today.”

“What condition is he in right now?”

“Not too bad.”

“Would you mind holding for a minute, doctor?”

“No problem.”

The instant I’m put on hold, some god-awful Perry Como-esque lounge lizard tune starts playing. Whoever invented muzak should be drawn and quartered. My mind drifts. Luba must be discussing the case with someone higher up the food chain. Does that mean she suspects I’m bullshitting her? I cross my fingers and continue holding.

Nearly a minute later she clicks back on.

“I’d like to speak to the client, please,” she says.

Oh crap. Is the Rock Man coherent enough to pass a detox phone screen?

“Um, I think he’s in the bathroom right now.”

Pretty lame, but it’s the best I can do on the spur of the moment.

“He’s not vomiting, is he? We definitely do not accept clients who are actively vomiting.”

How about if they’re passively vomiting?

“Oh no, he’s not vomiting, he’s just having a pee.”

“So he’ll be out shortly, then. I’ll wait for him.”

I jog over to Rocky’s stretcher. He’s fast asleep.

“Rocky! Wake up!”

“Eh?”

“I’m trying to get you a bed at the Pink Elephant. Come talk to the nice lady and tell her you’re okay.”

“Feel kinda pukey.”

“Just tell her you feel all right!”

“Okay, okay.”

I drag him over to the phone.

“Hi, Luba. This is Dr. Gray again. Here’s Rocky.”

I hand Rocky the phone. Is it just my imagination, or does he look a little green? Must be the fluorescent lights.

“Hello?” I hear Luba say.

“Huurr… .”

“Hello?”

“Huuurrrraaaalp!” replies Rocky as he covers the telephone with more Pop Tarts and Big Macs.

I guess I’ll be admitting him after all!

Alanna’s Birth

On the evening of June 2, 1993, Jan went into labour. The next morning our eldest daughter, Ellen, was born. Everything went smoothly.

On September 3, 1994, our second daughter, Kristen, arrived. Once again there were no complications.

By mid-October the following year Jan was two weeks away from the end of her third pregnancy. Over the preceding two weeks she had noticed a slight reduction in fetal movements, but it hadn’t been enough of a decline to concern us. On the morning of October 21 the baby stopped moving altogether. We contacted Miles, our family doctor. He was partway through a 24-hour shift in the emergency department. He asked Jan to come in for a non-stress test. To our relief, during the test the baby stirred a little. There wasn’t much beat-to-beat variability, though, so Jan was admitted for induction of labour.

By suppertime the Syntocinon drip was producing regular contractions and active cervical dilatation. At about 7:00 p.m. we started to see a few late decelerations. They made me jittery. I don’t do obstetrics, but I know late decelerations can sometimes be a sign of fetal distress. Half an hour later an artificial rupture of membranes was performed. The amniotic fluid that gushed out was nearly black with meconium. Our baby was in trouble.