Vignettes From A Night In The ER…

Goofy Female Patient: “I have a bread wrapper stuck in my throat.”

Ambulance Driver: “The same bread wrapper you had stuck in your throat on Friday?”

GFP: “Yes, and I can’t swallow! (Swallows several times and grimaces for emphasis)

AD: (mentally counting to ten) “Ma’am, three days ago you had a barium swallow x-ray and a couple other unnecessary tests, and none of them showed this bread wrapper.

GFP: Well it’s in there, and you didn’t get it! This morning it gagged me, and I almost got it out with my fingers, but it slipped back down.”

AD: (massaging temples and whimpering) “Ma’am, the x-rays would have shown it. There is nothing in there.”

GFP: “It’s got plastic around it! It won’t show up on an x-ray!”

AD: “Plastic wrapped around a piece of wire. Ferrous metal. You know, the stuff that basically glows in the dark on an x-ray.”

GFP: “Plastic.” (folding her arms across her chest petulantly)

AD: “Metal.” (accompanied by the sound of grinding teeth)

GFP: (testily) “Is the doctor going to give me a referral to the surgeon or not?”

AD: “Sure, I’ll go ask him one more time. I’m sure he’ll change his mind about calling a gastroenterologist at 7 pm and explaining that you need an endoscopy for a foreign object with absolutely no physical evidence that there is a foreign object, including irritation or swelling. Incidentally, does your health insurance include a Fairy Tale Rider?”

GFP: “A what?”

AD: “Never mind. The other option is that we can refer you to Dr. XXXX, who just happens to be on-site.”

GFP: “Isn’t he a shrink? Why would I need a shrink?”

AD: “Because apparently it will take a psychiatrist to convince you that there is no bread wrapper lodged in your throat.”

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System Abusing Psych Patient: “It’s me again!”

AD: “Sweet mercy, not her again…”

Local Paramedic: “Excuse me?”

AD: “Sorry, did I say that out loud?”

SAPP: “I overdosed on my medications!” (looking proud of herself)

LP: (rolling his eyes) “Two each of Trazadone and Haldol.”

AD: “Is that all? SAPP, were you trying to kill yourself, or were you just trying to get readmitted to the psych unit?”

SAPP: “Nah, I don’t wanna kill myself…right now. I just got tired of seeing all the snakes.”

AD: “And I’m sure the snakes are tired of seeing you. I know I am.”

LP: “So what will you you do for her?”

AD: “Wait five minutes, then call the Doc. She’ll need that long to compose a tale sorrowful enough to get her admitted to the psych ward for suicidal ideation. In the meantime we’ll get prepped for a little punitive gastric lavage.”

LP: “Punitive lavage?”

AD: “Because even though she may not need one, she damned sure deserves one.”

SAPP: “I ain’t getting no lavage.”

AD:Hmmm, I smell a challenge. Go get the leather restraints, LP.”

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Fearful Little Kid: “Am I gonna hafta get a shot?”

AD:Fraid so, Sport. But it doesn’t hurt so bad. I’ve given a gazillion of ’em, and I’m pretty good. In fact, I gave one to your Dad last week.”

Bodybuilder Dad: “That’s right, and it didn’t hurt a bit! Plus, you’re tough, aintcha Sport?”

FLK: (tearing up) “But I don’t wanna shot.”

AD: “Nobody does, but sometimes we need ’em so we can feel better. Tell ya what, you turn around and wrap your arms around your Dad’s neck and bury your head in his shoulder. Relax your legs, and if it hurts a little, scream ‘Purple Pig’ as loud as you can.” (quickly swabs a butt cheek and gives the shot)

FLK: “OW! Puuuuurp – hey! That wasn’t so bad!” (wiping his eyes in relief)

AD: (grinning and pulling a few stickers and a Cadbury creme egg from my pocket) “Told ya it wasn’t so bad. And I got some cool stuff for ya, too.”

Bodybuilder Dad: (in mock indignation) “Hey, you didn’t give me any cool stuff when I got a shot!”

AD: “That’s because you’re 35, and only half as brave as he was.”

FLK: (giggling around a mouthful of chocolate) “Y
ou’re a real wimp, Dad.”

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AD: “Want me to get the tube, Doc?”

New Doc: “No, I’ll get it! And we need blood gases…and a 12-lead EKG…and a chest x-ray…and I’ll need some Versed and Succinylcholine…and someone needs to get an IV…and..and…are you getting all this???”

AD: “Yup.”

New Doc: “Then why are you still standing here?”

AD: “Because I’m wondering how you’re going to ventilate this person without a BVM, or check breath sounds without a stethoscope, or suction her in case she pukes when we give the paralytics…and I’m really curious how you’re going to do all that stuff by yourself.”

New Doc: “Oh. Yeah. Well, first things first…”

AD: “Yeah, that’s what I was thinking. Let’s secure her airway and get her ventilated, and we can handle all that other business at our leisure.”

New Doc: “Okay, I’ve got the airway if you’ll go get – “

AD: “You said that before, Doc. But airway is a Team Sport, and right now I’m the rest of your team.”

New Doc: (fear and realization dawning in his eyes) “You mean…”

AD: “Yep. In this whole entire hospital, I am your only backup. Welcome to a rural Emergency Department, Doc. What we lack in volume, we make up for in pucker factor.”

New Doc: (swallows nervously) “Okay…”

AD: (sixty seconds and one gentle hip check later) “I got this, Doc. Grab the BVM and get ready to check breath sounds.”

New Doc: (very sheepishly) “Sounds like you’re in. Thanks for the backup. You made that look easy.”

AD: “Even a blind pig finds an acorn now and then, Doc. And you will have plenty of opportunities in the future to back me up, usually when my puckish wit and lack of an internal censor gets me in trouble.”

***forty minutes later***

New Doc: “Hey, her BNP is almost 1000! We need to start a -“

AD: “Nitroglycerin drip? Already running.”

New Doc: (confused) “But we just got these labs back! How did you -“

AD: “Know she was in heart failure and acute pulmonary edema? Because her family said she’s on a low sodium diet, and she just treated herself to five pounds of boiled crawfish. Plus, the fact that her blood pressure was 240/120 and her lungs sounded like a coffee percolator…”

New Doc: “Oh. Yeah. Well…you need anything else from me?”

AD: (handing him a list) “Well, you could write orders for all this stuff.”

New Doc: (eyes bugging out) “All this??? You’ve already done all this stuff?”

AD: (just a touch smugly) “Yep, and if it’s not too much trouble, you could also get started on arranging a transfer to Big City Memorial.” (turns to walk back to the treatment room)

New Doc: (stage whispering to Laid Back Male Nurse) “Is he always like this?”

LBMN: (chuckling knowingly) “Just let him do his thing, Doc. Check in on him every now and then and make sure he isn’t performing surgery or something. Sometimes he gets a little…enthusiastic.