Angels in the ER (29 page)

He looked at me expectantly and added, “Sometimes Oxycontin works the best.”

Oftentimes I wonder just what people are thinking, and what they take us for. Do they think we wouldn’t notice such a flagrantly inappropriate appeal? Or that we would immediately head for the drug cabinet and give them whatever they want? This guy obviously needed help, but it would be of a psychological nature, not physical. However, I knew he wouldn’t be interested in anything at this point other than procuring narcotics. And in the ER, it was almost impossible to provide the sort of assistance he ultimately needed. My job was to sniff him out as a drug abuser, frustrate his perfidious efforts, and send him on his way.

I was up to the task, and I knew it.

“Well, we’ll see what we can do to help,” I assured him, considering my best course of action here. “Can I take a look at your X-rays?” I asked.

“Sure, Doc, help yourself,” he answered, handing me the folder. “But could you please hurry? My leg is killing me.”

“I’ll be right back,” I replied, and stepped out of the room.

Jeff was pushing a wheelchair into the department from triage, laden with a middle-aged man. This latest patient was having trouble breathing and was obviously struggling.

“Shortness of breath and a history of emphysema,” Jeff informed me. “I’m taking him to room 6.”

I knew it would take a few minutes for Jeff to get him on the stretcher and get things started. I would have enough time to look at Mr. Glover’s X-rays.

“I’ll be right there,” I told Jeff. “Holler out if you need me.”

I walked over to the X-ray viewing box, took out the two X-rays in the folder, and snapped them into the holders at the top of the box. I stepped back and looked at the films. The first thing I noticed was the top right corner, the area where the patient’s ID information was usually included, had been cut away. Both X-rays were missing this same irregular rectangle. There was no way to identify the person whose images were before me on the screen. And then I noticed that at the bottom right-hand corner, completely contrary to any notational convention of which I was aware, someone had handwritten “John Glover” in black felt pen. No date. No identifying hospital. Hmm.

The X-rays were indeed of someone’s femur. And that person, whoever and wherever they might be, was certainly unfortunate. The X-rays revealed a large bone cancer sitting squarely in the middle of his or her thigh. But it was impossible to know when these films had been made, or where. What was possible to know was that this person had either lost his leg or his life. This was a bad-looking tumor.

Where had John Glover gotten these X-rays? Was it someone he knew, maybe a family member? Did he have access to some Radiology department somewhere? My curiosity was morphing into anger as I realized the depth to which this young man had sunk in order to satisfy his need for drugs. Whether he was using them himself or selling them made no difference. Then I remembered the patient Jeff had just taken to room 6, and I knew I would soon be needed. I left the X-rays hanging on the view box and walked across the department.

It took about 45 minutes to get our patient with shortness of breath under better control. He had developed pneumonia, superimposed on poor lung function induced by 35 years of work in a cotton mill. He was in less distress now, but he was still sick and would have to be admitted to the hospital.

Stepping out of room 6, I walked to the nurses’ station and remembered the X-rays John Glover had brought with him. I glanced over at the view box where I had left them. They were gone. The curtain of room 4 was drawn closed, so I assumed Mr. Glover was still there.

“Trish, did you see what happened to the X-rays I was looking at a little while ago?” I asked, motioning with my head toward the view box.

“Yeah,” she answered, not looking up from the work she was doing. “The guy in room 4 came out and went over and got them. He stuck ’em back in his folder and went back to his room. He wanted to know how much longer it was going to be.”

As I stood at the nurses’ station I could hear Jeff’s deep, reassuring voice coming from behind the curtain of room 6.

“You’re going to be alright, Mr. Jones,” he was saying. “You’re breathing easier now, and we’re going to be able to treat your pneumonia. You’re going to be okay.”

I couldn’t make out Mr. Jones’s response. But the thought suddenly struck me—here was a man who was struggling for his life. He had come to us for help, and we were giving him just that. We were doing what we were trained to do, and were doing it effectively. This is why we were in the ER at one o’clock in the morning.

Then I glanced at the curtain of room 4 and felt my face flush a little. This John Glover, or whoever he was, had no reason to be in this department. He was taking up our space and our time. I picked up his chart and walked across to his room.

For a passing moment, I considered flushing him out. I would go into the room and tell him that I had reviewed his X-rays and that he indeed had a very serious case of bone cancer. I would tell him I knew it must be very painful, but just to be sure where we stood, I was going to send him around to the Radiology Department for some current films. We would know more about the status of his cancer and be able to more effectively treat him. Then I would watch him squirm.

The moment passed, as did the temptation. As satisfying as that might be for me, I knew what I must do.

I pulled the curtain aside, and seemingly on cue he began rubbing his leg again.

“They haven’t brought me anything for pain yet, Doc. Any idea when that’s going to happen?” he asked. “This leg is killing me, and I really need to get on the road.”

I clutched his chart to my chest and lowered my head, fixing my eyes on his.

“Mr. Glover, I think we both know what’s going on here,” I began. “Those are not your X-rays and you don’t have bone cancer.”

He immediately stopped rubbing his thigh, and his head tilted ever so slightly to one side. He continued to stare at me.

“You’re not going to receive any pain medication here, or any prescriptions. You’ve taken up enough of our time, and I would suggest you leave this ER.”

I stopped and waited for a response. For a moment he was silent, and he just stared at me. Then very calmly, he picked up the X-ray folder and stood up.

“Doc, you can just kiss my butt.”

His shoulder brushed mine as he walked out of the room. I felt my face flush again, and I followed him as he walked toward the exit. I wanted to say something, something that would cut him to the quick, but I thought better of it. I was trying to regain control of myself and of this situation.

And then I remembered the X-ray folder. The doors to the exit had just closed and I hurriedly stepped toward them. What was I thinking? I needed to get those X-rays and destroy them. John Glover, probably using another name, would soon be in another ER, rubbing the same leg, asking for the same medicine, and exhibiting the same X-rays. Maybe even later this very night.

I was going to get those X-rays from him. That was the least I could do.

Stepping out into the ambulance area, I could just make out his shadow, retreating into the parking lot. There was no one else in sight.

“John,” I called out to him. “Hold on just a minute.”

I quickened my pace, determined that he not leave until I had what I wanted.

He stopped at the top of a small rise, silhouetted against the glare of a lamp post at the back of the large lot. Turning, he faced me, just forty or fifty feet distant.

“Hold up,” I called. And then he did something that made me stop in my tracks. He was carrying the folder in his right hand, and slowly he transferred it to his left. Then, nonchalantly but with obvious purpose, he shoved his right hand into his pants pocket and withdrew something. It wasn’t large enough to be a gun, but the fleeting glint of reflected metal registered somewhere in my brain. What was I doing?

He didn’t step toward me, just stood there, waiting. Silent.

I remained there for a moment, torn between walking up the hill and confronting him and simply turning and walking away. I looked at his right hand and tried to discern what object might be hidden there. He wasn’t that big a guy. How dangerous could he be? All I was interested in was getting those X-rays, nothing more. I wasn’t looking for a physical confrontation, and I would bet he wasn’t either.

Wait a minute! What was I thinking? There was no dilemma here.

I turned and walked back to the ER.

Once again at the nurses’ station, I addressed Trish. “You might want to give a few of the surrounding ERs a heads-up on Mr. Glover. Let them know his age and that he’s got some X-rays with him of someone with bone cancer. Drug seeker, and maybe dangerous. They can call me if they have any questions.”

I had a few minutes to reflect upon this encounter. I began to realize how foolish my behavior had been, and that I had let my emotions cloud my judgment. This had been a potentially dangerous situation and I had put myself in harm’s way. And for what? To prove to this man that I had sniffed him out as a drug seeker? That this was my ER and he was not going to walk in and make demands of us? That we were no local yokels, easily deceived and manipulated?

It was an issue of pride. I would have to overcome this and learn to be patient in these circumstances. I would need to learn to be more objective and more pragmatic. I would need to learn to control whatever it was that drove me to seek dominance in such a situation.

I was learning. But I wasn’t there yet. Another lesson awaited me, and this would be one of those rare times when I would be able to gain some valuable insight from the misstep of another.

6:30 p.m.
It was a busy Saturday evening. I was working with one of our young partners, Andy James. He had finished his residency training a few months earlier, and was bright, eager, and obsessive to an almost bothersome degree. He had come to us with a few rough spots, but we were all of the opinion these would soon enough be smoothed out. The ER of Rock Hill General had a way of doing that.

He was showing me the chest X-ray of a patient in room 5, asking for my opinion.

“Dr. Lesslie, does this look more like pneumonia or heart failure?” he queried, closely scrutinizing the films of this sixty-year-old man.

“First, Andy,” I responded, “I want you to call me Robert, not Dr. Lesslie. Okay?”

I had requested this of him at least a dozen times since his arrival, and after each such request he would try to make the attempt at less formality. Eventually, he slid back into using this appellation, a remnant of his still-fresh residency training.

“Okay, Dr…I mean, Robert. What do you think?”

We were discussing the sometimes difficult distinction between these two different problems, when we both were distracted by the squawking of the EMS radio.

“General, this is Medic 3,” the familiar voice of one of our paramedics announced.

Lori walked over to the phone and pushed the hands-free button, allowing her to speak to the paramedic and for us to hear what was
going on. Andy immediately walked over to the counter of the nurses’ station and leaned closer to the phone.

“Go ahead, Medic 3. This is the General ER,” Lori responded, taking out her pen and preparing to make some notes. She glanced at the clock on the wall and jotted down the time.

The paramedic proceeded to tell us that he was in transit with three patients from a motor-vehicle accident. And that Medic 4 would be bringing in another three from the same accident.

Andy’s eyes widened. He looked in my direction.

“Nothing serious,” the paramedic announced. “Neck and back pain. We have a few of them in full spinal protocol.”

“10-4,” Lori responded. “Minor trauma on arrival.”

“10-4 to that,” the paramedic answered. “Medic 3 out.”

Andy had been making some notes as well.

“Sounds like it could be something bad,” he said to me. “That’s a lot of PIs (personal injuries) in one accident.”

“We’ll see,” I answered, not yet impressed. Putting three patients in one ambulance was an indication the paramedics working the accident were not too concerned with the possibility of significant injury. And then there was the relaxed tone of the paramedic’s voice.

“We’ll see,” I repeated.