Vignettes From the ER


1110 hours

“Well howdy, AD!” the ward clerk greets me as I hustle into the ER. “Keeping banker’s hours this morning, are we?”

“My pedicure ran a little long. They had to change grinder blades twice. Please tell me that bloodthirsty horde in the waiting room is just someone’s family, and not patients waiting to be seen.”

“No such luck. Two more just signed in. It’s Drug Seeker Noah’s Ark Day. They’ve been coming in two-by-two.”

“Lovely. Who’s the Doc?”

Candyman.”

“Oh God. Shoot me now, please.”

1315 hours

“Hey, AD? Podunk EMS just called. They’re bringing in Princess again.”

“Damn. It. All. To. Hell. They say why?”

“Knee pain, fell a week ago.”

“Lemme guess. Drunk again?”

“As a boiled owl, according to Paramedic With Potential.”

“Good, then he knows where to put her. As long as she can sit in a wheelchair and maintain her own airway, she goes to the end of the line.”

1502 hours

“Hey dude, I need some water.”

“Huh, where did you come from?”

“From in there,” he says, pointing to the Quiet Room. “I got food poisoning.”

And a blood alcohol of 324, I muse, flipping through his chart. Amazing how that can upset your tummy.

“You’re not deathly ill any more? Sure you can hold it down?”

“I think so,” he nods weakly.

“Sure thing,” I say, filling a cup from the cooler. “Sign this for me first, please.”

“No problem,” he says agreeably, yawning as he scribbles his name. “What was that?”

“The paper that says you can go home as soon as you’re sober enough to walk. Thanks for the demonstration.”

“Huh?”

“Exit’s down the hall and to the left, sir. Don’t forget your water.”

1625 hours

“We have a problem,” the ward clerk informs me grimly.

“Shit, more patients?”

“No, but the ones in the waiting room are complaining.”

“About the wait? Tell them that waiting time is a consideration in choosing a restaurant, not an ER. If they’re well enough to bitch about the – “

“No, not about the wait. They’re complaining about Princess.”

“What’s she doing? Singing 100 Bottles of Beer On The Wall? Tell them she needs a good backup chorus. It’ll keep ’em busy.

“No, they’re complaining that she’s drinking out of a whiskey bottle in her purse. Getting belligerent, too. Says she’s tired of waiting.”

“Well, we can’t have that. The drunker she gets, the longer it’ll take to sober her up.”

“Who are y’all talking about?” Candyman wants to know.

“Knee pain in the waiting room, Doc. Apparently she’s resorted to a little nip for medicinal purposes, and demands a room befitting her regal stature.”

“Knee pain? Let her wait her turn. Knee pain isn’t gonna kill anybody.”

“We can only hope.”

1835 hours

“Only twenty five minutes until your shift ends, Doc. Hang in there.”

“Twenty-three minutes and forty-five seconds, actually. 44, 43, 42…

*ring ring*

“ER, this is AD.”

“AD, we need Dr. Candyman on the floor.”

“Shit. Does this mean you’re not ready to take the telemetry patient we’re admitting?”

“Not right now. We have a patient crashing and we can’t get a line.”

“Okay, he’ll be right there.”

“What did they want?” Doc sighs.

“They need you to start a central line. Looks like you won’t be getting off on time after all.”

“Shit. You got it here?”

“Go. We’ll keep the Vicodin Hordes at bay while you’re gone.”

1910 hours

*ring ring*

“ER, this is AD.”

“AD, Doc Candyman needs you in Room 124, STAT.”

“Shit,” I groan, closing the lid on my half-eaten Chinese takeout. “I’m coming.”

I sprint to Room 124 and find Doc Candyman cursing under his breath. The charge nurse has already rolled the crash cart to the bedside. Not a good sign.

“What kind of fucking Mickey Mouse hospital has central line kits with nothing but the catheter in them?” he fumes, loudly.

“Apparently, this kind of Mickey Mouse hospital. What’s missing?”

Everything, dammit! No introducer, no guide wire, no nothing! What a fucking piece of shit!”

Uuuhhh, Doc? Is she conscious?”

“Fucking cheap-assed, penny-pinching sonsa huh? Oh, her? No, she’s out like a light. And she’s gonna stay that way if we don’t get some blood into her soon.”

“Be right back, Doc.”

1915 hours

“Okay, we have a laceration tray with syringes, needles, sterile drapes and forceps. We have a peritoneal lavage tray we can cannibalize a Seldinger wire, introducer needle and dilator from. Anything else you need?”

“Just glove up and gimme a fucking hand.”

1945 hours

“This ain’t working, Doc. We’ve missed three femoral attempts and two internal jugular attempts. Any other ideas?”

“Shit. We can call Friendly Surgeon and see if he can come put one in.”

“It’ll take him an hour to get there. Better get on the phone now.”

“I don’t think we have an hour.”

2000 hours

“Damn, is that what I think it is?” Doc Candyman wants to know.

“Yep. It took some doing, but it works. We got the blood going.”

“I wonder what’s the record for oldest patient to ever get an intraosseous needle?” he muses.

“I don’t know, but I just shattered my personal best. By eighty-five years.”

“Thank God. Friendly Sur
geon is still forty minutes out.”

[And I didn’t do it with any newfangled drill thingy you kids use these days. Nosirree, I did it the old-fashioned way, using persistence and brute force. Back in my day, we had to put in our intraossoeus needles in by hand, and by God, we were grateful.]

2115 hours

“Hey Doc,” I ask as I chart with one hand and shovel cold broccoli beef into my mouth with the other, “refresh my memory. What do they call the region directly above the vagina?”

“The mons pubis,” Favorite Doc answers absently, scrolling through CT images on the viewer. “Why do you want to know?”

“I’m charting on the land whale with the abscess right above her hoo ha. The clinical term slipped my mind.”

“Well, technically the structure right above the vagina is the clitoris.”

“Damn. Is that where it is? No wonder my wife left me. All this time I thought she had tired of my boyish charm and my witty repartee.”

2315 hours

“Damn AD, where you going with such a grin on your face?”

“Home! I have a cyber date with a beautiful blonde.”

Ewwwww. I don’t need to hear about you surfing internet porn.”

“Nah, it ain’t like that. She keeps trying to entice me into naked webcam action, but I told her I won’t put out until we’re married. I’m old fashioned that way.”

“Riiiight.”

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