Emergency! (19 page)

I retired to the washroom to rinse the sputum off my face. A lump
was rising on my forehead, a pain was raging behind my eyes. I sat down in a back room to compose a note that looked favorably upon this occurrence. Even from the back room I could hear the strident voice of the intern trying to calm Mr. Rios enough to suture his laceration. Mr. Rios was winning this encounter. Mr. Ortiz was now echoing Mr. Rios's “FUCK YOU, FUCK YOU, FUCK YOU, FUCK YOU …”

Later in the evening, Mr. Rios took on a cop who was standing near. The cop was one of the many that keep an eye on patients that are handcuffed and in police custody. Mr. Rios continued in his usual MO—“Suck my cock,” etc., etc. I sat behind the counter admiring how this cop could take such abuse without comment. He did not tell Mr. Rios to shut up or quiet down. He did not threaten him with arrest, or physical harm. His refusal to acknowledge the abuse only enraged Mr. Rios more. I wondered if they give the police a special course in this technique. Maybe he is so used to street crime and physical violence that this abuse does not bother him. Maybe he is deaf? I was feeling less of a man for overreacting to Mr. Rios's abuse. I was about to get up and offer the cop a cup of coffee when I noticed him looking from right to left, down the hall. He took two quick steps to the wheelchair, and when he thought no one was looking, gave Mr. Rios a left hook that snapped his head backward. He slumped in the wheelchair again, his right eye closing with a hematoma.

Two new injuries and a significant amount of Valium were not enough to chasten Mr. R. Within minutes he was awake and abusing staff members. Despite the fact that there were more tests pending, I discharged him onto the street, escorted by our biggest security guards, before someone put a bullet in his head. I wonder how this guy lived to be twenty-six-years old.

Mr. Ortiz was admitted upstairs. His final comments to the ER he had entertained for seven hours were, “BED 9 WINDOW, BED 9 WINDOW, BED 9 WINDOW,” so we all knew the bed he was going to.

Cathy is pregnant. Suffice to say, I am pleased. Last week I went on an interview at TELOS Laboratory Associates, a pharmaceutical research
firm. I listened a long time to their spiel, then told them I was morally opposed to human experimentation if I was paid only sixty-five thousand dolla a year. I can't believe I've even considered a research job! I hope your wee man is doing well and that you have not demented his mind with hospital stories.

Warm regards,

Campion         

Dear Larry,

Today I took care of a young professional couple. They were minding their own business, watching a video in their swanky Village apartment, when a ring at the door announced a persistent solicitor. Mr. Smith opened the door and was smashed in the face with a gun butt. Two men entered the apartment, drew pistols, and threatened to kill the couple if they screamed. The assailants calmly and methodically ransacked the apartment, looking for money and valuables. Satisfied that they had everything they could carry in their bags, they turned their attention to the Smiths. Mr. Smith was beaten unmercifully, and with a gun to his head, his wife was forced to perform oral sex on the other perpetrator. Next she was raped and sodomized by both intruders as her husband watched. The Smiths were bound and gagged, as the burglars made several trips to empty the apartment. The couple was found by neighbors in the morning when their door was noted to be open, and they were brought to the ER.

Mrs. Smith had the vitreous look of those involved in major trauma. She spoke little, and then in monosyllables. She gave an eerily calm monotone description of the attack. Mr. Smith wasn't much better, with his facial-bone fractures and scalp lacerations. He didn't answer most questions, nor did he react when injected with tetanus toxoid or lidocaine when suturing his wounds.

I had a strange feeling of guilt while examining Mrs. Smith. The exam is intrusive. During the interview, the doctor is in charge of
gathering information and evidence. One must ask all the unpleasant details of Who?… How many times?… How many attackers?… Orally?… Rectally?… The examination involves a pelvic and rectal exam. We are looking for trauma, semen, blood, and saliva. Hair samples are pulled from her head and pubic area; the pubic hair is combed for stray hairs of her assailant, which may be matched with the assailant's if he is caught. Bite wounds are swabbed for traces of saliva, which also may be matched with the assailant's. The exam is a significant invasion of a patient who does not need any more stress. All during the exam, Mrs. Smith was staring blankly into the ceiling as I and two nurses discussed the wounds, documented findings, bagged evidence. I was happy to turn the case over to the rape-crisis counselor. There was no counselor for Mr. Smith. He was sent to the head and neck service for repair of his fractures. Mrs. Smith went home with her sister. As usual, the police were all over the ER, hogging the phones and writing space. I asked the sergeant what the chances were of the assailants being caught. He laughed and said something sarcastic about them feeling guilty and turning themselves in later today.

I can only imagine the tremendous feeling of paranoia one must have after an incident like this, knowing one's home is not safe. Wondering every time someone rings the doorbell, Is this another rapist, burglar, or worse?

This case really hit close to home. I've reminded myself to add a deadbolt to our door at home, and am thinking again about purchasing a handgun. That couple had so much in common with us. I don't know if I can tell Cathy about it. She's going off to St. Thomas in the Virgin Islands to get some sun with her sisters before the baby comes. Maybe when she gets back I will.

Be safe, 

Campion

Dear Larry,

Yesterday morning when I left for work I felt like I was getting the flu. I had slept poorly the night before and hoped for a calm day. It was not to be. The day was filled with the usual amount of inner-city nonsense. I became preoccupied with watching the clock and how slowly it seemed to move. I know it's a bad day when I start by saying, “Only eleven and a half hours to go!” The day dragged on without a chance to sit down or eat.

Needless to say, I was very happy when Patty Flanagan arrived to replace me. Patty and I went to medical school together. She's now a pulmonary fellow and works one or two nights a week to supplement her salary. She's an extremely bright, hardworking physician, and usually takes up all the slack in the ER when she's here. I was looking forward to a trip to the gym for a quick workout and a simmer in the Jacuzzi. While signing over cases on rounds I noted that Patty was quiet and appeared pale. I tried to ignore it, but when she left rounds to vomit in a wastebasket, it became difficult. Everyone was uncomfortably looking at one another, then down at their shoes. We all knew that the ER could not be left unmanned, but no one was interested in staying. Patty returned to rounds, said she was “OK,” and we continued. When rounds were finished there was a general rush for the door by the attending staff. I was left with Patty, and in my medical opinion she looked like shit. I suggested that she take some Tylenol and Compazine and rest for a couple of hours while I covered things for her. I felt bad for her since she would have to be on duty the next day, sick and without any sleep, to work with the cancer patients. It seemed like that job was depressing enough without the added burden of being sick and exhausted.

The evening traffic was picking up and I was getting more weary. I had not eaten since morning. It was now 10
P.M.
and the Jacuzzi closed at eleven. I decided to call it a night and went to look for Dr. Flanagan. I found her lying on the floor of the coffee room, looking even more pale and sweaty. I picked her up, hoping against hope that
she was practicing an unusual form of meditation, but it was not to be. She was febrile, very ill, and could barely move. I toyed with the idea of having the patients come into the coffee room and tell her their problems as she lay on the floor, but I didn't think it would really work. I was screwed.

I called my boss, Dr. Kleiner, looking for help. He told me that he would make some inquiries to see who was interested in coming in at midnight. I thought of someone calling me at 11
P.M.
to ask if I wanted to work all night in the ER, and knew no one would even pick up the phone at this hour. I also knew Kleiner wasn't about to come in, but I called him back at midnight anyway, just to let him know how I was doing. He told me he was concerned, and that if I left the hospital unmanned I would be liable for a patient abandonment suit. I thanked him for his concern and assured him I would call again at 3
A.M.
to let him know how the night was going.

The night turned hellish. I saw a young man come into the main ER flanked by nurses from triage. He was covered with blood—not all that unusual, but triage nurses never come into the ER so I was concerned. I walked over to him and introduced myself. He was holding his abdomen and in a very calm voice stated that he had been robbed and stabbed. I asked him if I could look at the wound, he released his hand from his abdomen and his intestines fell to his knees like a bloody apron. “I think we need the trauma team!” someone yelled. In the trauma room I started a few big lines, pushed in fluid, ordered some O-negative blood, and put a wet dressing on his abdomen. When the trauma team arrived, the surgical residents looked at his wound, then grabbed the stretcher and ran for the OR with smiles on their faces. Ordinarily they hang around the sickest ER patients, asking for different X-ray views and clotting profiles while discussing how you are mismanaging the case. But when there is a true emergency, they really can hotfoot it to the OR. They love to operate. Mr. Intestines did well, according to an intern who scrubbed on the case. He said that despite the dramatic appearance of the wound, no vital organs had been violated. He sounded disappointed.

Right after that, a guy working the night shift in a print shop uptown
tried to remove a loose bolt from one of the presses while the machine was on. His right hand was crushed from the mid-forearm downward. The hand, surgeons said, was not salvageable, and the ortho residents removed the crushed part in the OR. They sent him back to the ER for a tetanus shot and a dose of antibiotics and said he should be discharged. This seemed cruel. I think that if you lose a major body part, you are entitled to at least one night in the hospital. I couldn't reach his wife. She was working a night shift. I felt bad, the guy losing his hand and all, so I gave him some morphine and let him sleep in the already crowded ER. In his sleep, I noticed that he tried to scratch his scalp with the hand that was not there.

Around 3
A.M.
a woman came in with a complaint of “pelvic pain.” I noted on the chart that this twenty-eight-year-old white female listed “dentist” as her occupation. I made some introductory remarks about the field of dentistry, trying to break the ice before I invaded her body. She was an attractive blonde with short hair and round horn-rimmed glasses that gave her a studious, yuppie look. My soliloquy was interrupted by Miss Dentist requesting that she be examined by a female doctor. I took this as a warning sign, and shot a glance at the nurse in the room with me. ER litigation is filled with women reporting that doctors examined them in an improper fashion. Granted, they may not know what is proper, but this doesn't stop a lawsuit from ruining a reputation. I wanted to run out of the room and get someone else to see her. I quickly explained that I was one of four male doctors in the ER, but if she wanted another doctor she could wait a few hours to be seen in the GYN clinic. She replied she was much too uncomfortable to wait and would agree to be examined by me if the nurse left the room.

Now I was really frightened! No way! “State law says you have to have a chaperon for GYN exams, for your own protection,” I stated with gravity. This was bullshit, but I thought it sounded convincing.

I left the room to have the nurse sound her out. After several minutes the nurse came out and pulled me to an area several yards from the door of the room. “She has something caught in her vagina,” she said.

“Like what? A tampon? A condom? A diaphragm?”

“No, something out of the ordinary.” She smiled.

“A vibrator? A Coke bottle? A billy club?” I offered.

“No,” she insisted, “out of the ordinary.”

I thought, This nurse must be losing touch with reality or has spent too much time in the ER. I was really too tired for guessing games. “I give up.”

“A room deodorizer.”

“A what?”

“You know, one of those mushroom-shaped things that keep your living room from smelling like your cat. She's tried to get it out for two days, and now it's getting painful. She drove all the way from Jersey to avoid seeing anyone she knew. She's pretty embarrassed.”

I knew better than to ask how the mushroom had gotten there; last year I had made the mistake of asking a young man how a teacup had found itself in his rectum. What followed was a long, totally startling story that I immediately regretted asking for. He told me he was painting the ceiling on a ladder, and fell onto a couch on which he had placed his cup and saucer. And well, you know, it just got stuck up there. Hmmm, let me picture this: You're painting the ceiling. Nude. On a ladder. Intermittently sipping tea. Yeah. I can see it.

I reentered the room. The dentist was crimson. I assumed my flattest affect. I really did feel sorry for her, and wanted this to be over for both of us. The deodorizer was removed easily with the help of a forceps. The floral design was still visible, but it was not emanating the “fragrant springtime bouquet” advertised on its side. It was placed in a sterile container and sent to pathology, as are all foreign objects removed from people's bodies. I thought of my former classmate, a pathology resident, who would be examining this specimen in the morning. I decided to give him something to think about and jotted a quick note on the pathology request form. “Mushroom found on routine vaginal exam. Suspect new vaginal flora. Could this have grown there?”