Emergency! (7 page)

At this point in my career I had had limited experience with conscious sedation. As I was of petite, feminine stature, I decided that anything which would assist my finesse would be an asset and agreed to Mom's request. Following a discussion of the pros and cons, and after obtaining consent and administering a generous dose of narcotic, the nurse and I began to prepare for the procedure.

Within twenty minutes we were poised and ready. IV, monitor, and pulse oximetry were all in place. The anesthetic was given and we waited for him to settle into twilight. In about five minutes he seemed appropriately out. The nurse and I quietly moved into place. My plan was simple enough: Remove the pillows; extend the leg and simultaneously apply pressure to the lateral side of the patella. Presto—patellar reduction!

I quietly spoke some reassuring words to David as I began to lift his leg and cradle it in my arms. Suddenly his placid demeanor was replaced by moaning. Low and plaintive at first, his moans soon changed character. The tempo accelerated and the volume began to crescendo.

Criminy, I thought, I haven't even removed the pillows yet. I braced myself and continued.

“Mmmmmm. OH! Ohhhhhh! OOOOOHHHHHHH! OH! OH! OH!”

I felt a little flushed and looked up at his mother. “I know this all sounds quite awful, but David really can't feel much and he won't remember anything after we're finished,” I assured her. She nodded quietly. Determined to get on with it, I slowly and purposefully resumed the procedure. This time my efforts were met with more animation and louder vocalizations. One could not help but notice that they were beginning to take on the distinct tone and cadence of
the soundtrack from a pornographic movie. I glanced across the bed at the nurse. She had the pained expression of someone straining to maintain professional composure.

“OOOOOhhhhhh … OH! OOOOWWWWWW! OH! OH! OH!” By now he was sitting straight up on the gurney, eyes wide open, howling wildly. “Oooooooh. Oooooow! Oh, God! Oh, God! OH! OH! OH!” As squeamish as I am about causing pain for my patients, I was becoming even more uncomfortable with the scene being created, and I was acutely aware of turning a deeper shade of red. As his bleating continued, I felt perspiration forming on my upper lip and brow. I was grateful to feel the patella suddenly settle into its proper position.

“Wh-Wh-WOW!” he shouted, then dropped back onto the pillow. For a moment he lay there quietly, eyes half closed, with a peaceful countenance. Then, slowly, he opened his eyes and met my gaze as a lazy grin spread across his face. “Got a cigarette?” he asked in a loud baritone voice.

My blush was now complete. I was sweating and my hair was tousled. I allowed an embarrassed chuckle to escape and turned to his mother. She stood with arms crossed, gazing at the ceiling, her foot tapping in nervous agitation.

Sensing her discomfort, I decided to exit. I slid open the exam room door and looked out at the nurses' station. My gaze was met by a gallery of slightly open-mouthed faces quietly staring at our room. Slowly the stares gave way to contorted smirks and grins. I glanced around the department. From nearly every exam room door there peered a curious head. I drew a deep breath and strode with pseudo-confidence to the nurses' station. “I guess they think we run a full-service department here!” the charge nurse said.

SUSAN K. SUCHA, M.D.

Omaha, Nebraska
    

A
n attractive couple in dinner attire came in to the Emergency Department, both holding extremely bloody towels. The male was clutching his towel over his groin, and the woman had hers wrapped like a turban around her head. Both were very uncomfortable.

They were reluctant to talk about what had happened. Physical exam of the man revealed several deep lacerations of the penis. The woman's physical exam showed multiple puncture wounds to her scalp that were oozing blood. After some coaxing, they told their story.

They had been enjoying a candlelit dinner together and after several glasses of fine wine, they were feeling romantic. For a special dessert treat, she slipped under the table, unbuttoned his trousers, unloosed his penis, and took it into her mouth. Suddenly, in the midst of the act, she had a full-blown grand mal seizure: her jaw clamped down tightly and her head shook back and forth like a dog with a rag. In a frenzy of pain and terror, the man grabbed his dinner fork and began hacking at her head until the seizure stopped and she relaxed.

RANDAL P. DEFELICE, M.D.

Spokane, Washington
    

O
ne Friday night the paramedics brought in an unconscious woman from a terrible car crash. We feared the worst and began searching her purse for the next of kin. While cataloging her personal items, we discovered a stack of pictures featuring the woman and a man in various revealing poses, costumes, and acts. The staff loved them and swapped them around like baseball cards. The secretary came back and said that the woman's husband was at the desk asking for information. Wanting to get these embarrassing pictures out of circulation, I gathered them together, put them in the woman's purse, and told the secretary to give it to the husband. I would be out to talk with him in a moment.

I went out to see him, expecting to recognize him on sight from his photo spread. The husband, however, was not the man in the photos.

I told him that his wife's condition was critical and that she would need to be in the intensive care unit. He listened intently, clutching the unopened purse. At this time the husband's friend came in from parking the car. I immediately recognized him from the photos.

I left them there, these two friends, and returned to care for the woman. She was admitted to the ICU and soon recovered and went home. I don't know what happened to her marriage.

As for me, I finally understood why my mom told me always to wear clean underwear.

NAME WITHHELD AT REQUEST OF AUTHOR

I
n the great state of Texas there lives a nasty little poisonous asp called the coral snake. It has three bands of color for easy identification: red, yellow, and black. In the same area lives a copycat snake hoping to garner respect from predators by looking like the coral snake, but the copycat snake has not one whit of venom. Its bands are also red, yellow, and black, but in a different sequence. Texans, a crafty lot, have developed a little rhyme concerning these bands of color to help them distinguish the poisonous snake from the harmless one.

A man soon to be our patient, his wife, and their two children were out on a picnic. The kids discovered a multibanded snake and excitedly called the parents over. The snake was about eighteen inches long and banded alternately red, yellow, black, yellow. Mom dutifully recited her best recollection of the poem: “Red on yellow makes a good fellow!” So Dad, not in the habit of disagreeing with his wife, picked up the Texas coral snake to show his kids proper snake handling. The coral snake, although normally quite timid, was alarmed at this intrusion and chomped Dad between the thumb and forefinger. Dad screamed but had the presence of mind to drop the snake into an empty ice chest and bring it with him to the emergency room.

Dad did well with only a swollen and painful hand to show for his
trust. Mom seemed a bit sheepish and the kids were alert but quiet. The emergency room staff was thrilled to have a visit from Mr. Snake and put him on show-and-tell in a plastic canister for the day before releasing him to the care of the forest service.

BILL DAVIS, R.N.

Austin, Texas
  

I
t was our usual busy summer Saturday evening in the Emergency Department. Accident victims, strapped down to backboards with neck collars in place, lined the halls. A young male accident victim was being comforted by a fiftyish woman who spoke soothingly to him as she stroked his cheek and kissed his forehead. The young man looked rather anxious but lay quietly immobilized.

Before long the woman began complaining about the wait for attention. A nurse patiently explained that we were very busy, and that although it is frustrating and uncomfortable to wait, they could safely do so until a physician was available. The woman seemed not to fully understand this explanation, and went on to complain more and more loudly and less and less coherently. Finally, she announced that it was not the young man she wanted treated, it was she herself. Indeed, she did not even know the young man she was stroking, but was a registered patient herself wanting to see a psychiatrist. With one
final shriek, she dramatically left the Emergency Department, climbed into an empty ambulance, and sped off into the night.

After reporting the incident to the police, we contacted the ambulance company to inform them of what had transpired. There was a tired acknowledgment in the dispatcher's voice when he said, “I guess that explains it. Some lady just called me and said that our ambulance had pulled up on her lawn and our attendant was at her door demanding food.”

STEPHEN J. PLAYE, M.D.
     

Springfield, Massachusetts

T
he flaccid body of eighty-seven-year-old Frank Jenkins is rapidly wheeled past the front desk into trauma room 1. He is intubated. CPR is in progress. The paramedics have been working on him for ten minutes. He's not responding. The room is suddenly enveloped in the controlled confusion of a Code Blue, then all falls silent when the patient dies moments later. The code team disperses, leaving only the tech to clean the body and straighten the room in anticipation of family viewing.

Frank's story emerges. With winks and grins the paramedics describe the 911 call to the Doll House, one of the mobile trailers on the edge of town. They relate finding an attractive, nude young woman performing CPR. The policeman interjects that by the time he arrived at the scene for his interview, she was wearing pants but was still topless. The woman reports that Frank was a regular patron of the Doll House, and that everyone there was fond of him.

I am asked to return to trauma room 1. A spirited discussion is raging among several female staff members as to whether the erect eight-inch penis is indeed Frank's original equipment. I assess the situation and assure them Frank has benefited from the skill of a surgeon.

We need to notify the family. We finally find a number for his son and tell him his father has died.

Minutes later he is at the front desk asking to see me. We go to the quiet room and I tell him the whole story. He is profoundly disturbed and begins to piece together the explanation for behavior that has previously been a mystery. Now it all seems clear: the sudden disappearance of life savings, which must have been used to finance the prosthesis; the regular requests for extra money to pay the household bills, which must have been passed on to the Doll House.

Our eyes meet. “You know, you think you know a man, and come to find out you really don't,” he says. He gazes off for a moment at nothing. Then he suddenly smiles. “But I'll bet that crafty son of a bitch died with a smile on his face.”

M. C. CULBERTSON III, M.D.

Dallas, Texas
                 

T
he little boy was four years old, with golden hair and deep blue eyes and the sweetest round face, frozen in the smile of an angel. He was also dead. Not technically, for the moment at least, but as good as, for he had drowned in a warm-water pool, and had been
revived too late to save anything but a few terminal hours of heartbeats. Even that was tenuous, and it was getting harder and harder to keep him “alive” at all. What with the hopeless prognosis for his brain, and the inevitability of his early death, it was time to decide to stop.

His parents were in the ER, overwhelmed with grief, uncomprehending, frightened, guilty—like many parents I've had the great and terrible fortune to meet in moments like that. They had a special request, though: They would let us stop resuscitating the boy, on the condition that they be allowed to perform a religious ceremony, at his bedside, before he died. In fact, they had their family preacher with them.

I had no problem with this, and at eleven in the morning, with the ER otherwise pretty quiet, I decided to stay in the room. Besides, I had agreed to do everything possible to keep his heart beating until the ceremony was complete, so one of us doctors would have to stay with him anyway.

The purpose of the ritual, I suppose, was to let the parents say good-bye to their child, in their own way. So the preacher, who went first, spoke for only a minute, and said nothing beyond the usual “all for the best” and “God's will.” Then it was the father's turn; the mother wouldn't have a turn, because it wasn't a woman's role in their religion, I guess. But she stood at the head of the bed, and held her son's hand. From time to time a moan escaped her, only to be stifled as soon as she could regain control.

The father, meanwhile, stood at the other side of the child's head, and spoke to this beautiful little boy, almost as if he were really in the room with us, almost as if the ET that passed down his throat and between his vocal cords would have let him answer if his brain weren't so very dead.

“Adam, my son,” he said, “you have been called to God. I know how frightened you must be, thinking that we have left you. But don't be afraid, my son, please don't be frightened. We didn't want to leave you. It's just that God took you away from us. Please don't be frightened,” he repeated, perhaps to himself as much as to his child.
After a pause he slowly continued. “And even though your mother and I are crying, deep in our hearts we are happy, for you.”