Sunday, March 12, 2006

Scenes From An Emergency Dept

~Setting: An Emergency Department Near Me~
The man strides into the ED with the purposeful walk of someone who knows where he's going. He makes a decisive turn into an alcove of beds, then realizes he's hit a dead end and pauses, raising his head. That's when I see that he may have just walked the walk, but his eyes talk the talk of someone who is dazed and in shock. We lock eyes for a moment, just enough time for me to think about asking him where he's going...and then the police rush in, spin him around, and guide him quickly to the trauma area. As he walks past me I see that his shirt is soaked in blood...

He gets thrown onto a bed in the trauma room and some nurse deftly cuts off his shirt and pants with a pair of surgical scissors. Turns out he's been, oh, shot in the belly a few times. He says he's not in any pain, and he seems pretty alert and oriented. People are yelling all around him, while he just lays there. Someone demands a hole count. 1, 2 on the front. 3, 4 on the back. Seems like there's a 5th on his side, but it might just be an abrasion. So there's a good chance the little suckers are sitting on a sidewalk somewhere, hanging out after their brief sojourn through our patient. Who, we finally realize, minutes after he arrives, has a name. I'll call him Ron Esdaile (obviously not his real name, or anything like it). In any case, at this moment we care a whole lot more about Mr. Esdaile's blood type than his name, and more yelling and prodding and needlesticking ensues for a few precious more minutes until we can finally send him hurtling down to the OR for a thorough checkup. Whew.

He seemed totally fine this whole time, even though he could have been bleeding internally and was going to crash any second, and even if not, a little piece of his yellow omentum was most definitely peeking out at us through one of the the bubbling little holes in his belly, and my goodness--this man had just gotten shot with a gun!

Throughout the ordeal, while I was standing dutifully behind the thick red line on the floor (in life there are the Haves and Have Nots; in medicine there are the Useful and the In The Way....guess which one I am...), I was struck by the fact that this man was not only alive, but seemingly alive and well. After having gotten shot. Several times. With a gun. And bullets that tore clear through to his other side. I've heard about guns, played video games with guns, seen lots of guns on TV and movies--but until Mr. Esdaile walked in, I had never been so close to the actual firing--and almost killing--of a gun.

I likely could have stayed lost in my philosophical reverie for plenty longer, but just then one of the front desk people came over and said that Mr. Esdaile's wife was in the family room to get an update on his condition. Interested in getting more experience in how doctors tell families good and bad news, I asked my attending, Dr C, if I could tag along. She said sure, so we headed over to the family room, where we found a woman sitting inside. For a split second, it occurred to me that she looked a little bit older than I would have expected Mr. Esdaile's wife to be, but who am I to judge...

Dr. C: Hi, I'm Dr. C. Are you Mrs. Esdaile?
Mrs. E: Yes, I'm Mr. Esdaile's wife.
Dr. C: Ok, so are you aware of what happened to your husband? When did you last see him?
Mrs. E: Yes, I know what happened; I was with him in the ambulance. How is he?
Dr. C: Good, so as you know, Mr. Esdaile was shot several times in the
Mrs. E: ~develops a look of shock/confusion~
Dr. C: Now don't worry, he seems fine. He's talking, awake--we just senthim to the OR to--
Mrs. E: ~interrupting Dr. C~ My husband wasn't shot!
Dr. C: ~develops a look of shock/confusion~ Umm...are you sure?
Mrs. E: Yes, I'm sure! I was with him in the ambulance!
Dr. C:'re Mrs. Esdaile, right?
Mrs. E: Yes, I'm Mrs. Esdaile!
Dr. C: Uh...and what do you think your husband came in for?
Mrs. E: I don't think--I know! My husband came in for a psychiatric issue--they said I could see him, then pulled me into this room!
Dr. C: Oh my goodness, I'm so sorry! This must be a terrible mistake--another man with the same last name--a different Mr. Esdaile--*just* came in here who got shot.
Mrs. E: Oh, wow!
Dr. C: I'm SO sorry--that must have been very strange for you...
Mrs. E: Uh, yeah, pretty much.
Dr. C: Uh, why don't I go find out where *your* husband is so you can see
Mrs. P: That would be great, thanks.
~close scene~

Hey, I don't make it up, I just tell it like it happened. There was also a guy who came in begging for a rectal exam because he was "100% positive I have glass up my ass". The X-rays showed nothing out of the ordinary in his rectum, and he was sent home, grumbling about the incompentance of the medical profession. In contrast to that clearly dissatisfied customer, we had a young woman come in with a history of two weeks of terrible abdominal pain. In her case, the imaging showed a clear cause for her muscular distress: the 12-week-old fetus growing inside her belly, doing some new expansions on its uterine home. After that news, she forgot about her pain altogether, and went home glowing, even though we hadn't actually *done* anything more for her than we'd done for Mr. Glassy Ass.

I'm gonna miss the ED. Sigh. But no time to dwell--coming next....tales from anesthesiology!


Post a Comment

<< Home