Angels in the ER (4 page)

It was two in the afternoon on a cold and clear Tuesday in February.

“General, this is Medic 1, over.”

I recognized Denton’s voice and picked up the ambulance telephone. Denton Roberts was one of the lead paramedics for the hospital’s EMS. He was in his mid-thirties, bright, aggressive, and his assessments in the field could always be trusted. He had attended Clemson for a couple of years and given some thought to applying to medical school. Once he started working as a paramedic, though, he knew he had found his niche.

“Medic 1, this is Dr. Lesslie, go ahead,” I responded.

The receiver crackled briefly. “Dr. L, we’re bringing in a 65-year-old man with abdominal pain.” There was a momentary pause. “It’s Slim.”

That was all he needed to say. I looked around the department to see which bed was available. “Bring him to room 2, Denton. What’s your ETA?”

“About five,” he said. “Room 2 it is.”

I placed the phone back in its cradle.

Slim Brantley was one of our “regulars.” He had been a regular since I began working at Rock Hill General. Depending on the time of year, we might see him once or twice a week. When the weather was good, he might go a month or so before calling an ambulance and coming to visit. We were in the midst of a cold snap, and this would be his third visit in the past nine days.

Lori walked up to the nurses’ station with a clipboard in her hand.

“We’ve got a friend coming in,” I told her.

“Slim?” she guessed, placing the board in its rack.

“Yep,” I answered. “Again.”

“Well, it’s been two days, so I guess it’s about time. Abdominal pain?” she queried, knowing the answer.

“Bingo.”

Lori Davidson had been working in the ER for seven or eight years. She was the mother of three young children, a boy and two girls. She had a quiet, unassuming demeanor, and yet she displayed a confidence and compassion that immediately put our patients at ease. I was always glad when she was on duty.

“I’ll get Slim’s room ready,” she told me.

It requires a significant effort to reach the exalted status of “ER regular.” Not just anyone achieves this lofty appellation. At any given time, we probably have only ten or twelve people in that circle. Just the fact that you come to the ER on a frequent basis does not necessarily make you a regular. We have drug seekers who do just that, but we don’t consider them regulars. That’s a whole different set of problems. Our regulars come to the ER over and over again with generally the same complaint. It might be abdominal pain, as in Slim’s case, or alcohol-related issues, or back pain, or seizures. It can be any of a number of things. But each of our regulars has developed their own unique handle.

For years, one of our favorite and most persistent regulars was a woman named Sarah May. She was in her sixties and lived with her older sister. At some point, she had become convinced that a root doctor practicing in Rock Hill (I’m not sure if he was board-certified in that specialty) had put a snake in her. I think it was a black snake. But she was absolutely positive a snake was crawling around in her belly. She would writhe on the stretcher, rub her abdomen, and plead with us to get the snake out of her. What do you do with that? Invariably, she came to the ER by ambulance, usually a little after midnight. EMS would call in with “We have a woman here, in no apparent distress. We’re at 100 Pine Street.” That was all we needed: her address.

“It’s Sarah May again,” would be the universal response. And in about fifteen minutes, she would be rolling into the ER.

Over the years, things changed with Sarah. On several occasions, I had her committed to a psychiatric hospital in Columbia for an evaluation. After a week or two, she would end up back home. She didn’t like this experience, and didn’t like being committed to a mental hospital. Apparently they had as much luck getting that snake out of her as we did. Eventually she developed the practice of calling the ER before she called EMS.

“Is that Dr. Lesslie on duty tonight?” she would ask our secretary. When the answer was in the affirmative, there would be a pause, a faint sigh, and then “Oh, well…” followed by a click. And no visit that night. But there were plenty of other visits for her, and her ticket to the ER was always that snake.

Slim Brantley, for whatever reason, had chosen abdominal pain as his handle. Or maybe it had chosen him. Though he had been worked up on numerous occasions, no pathology had ever turned up. He did have some real disease, though. Too much alcohol and three packs of cigarettes a day had taken their toll. He had very little lung reserve and had become very susceptible to pneumonia. And his heart had been giving him problems lately, as shown by recurrent episodes of a rapid heartbeat and dizziness. Those things were real. But his abdominal pain was not. It was his free pass to the ER, and it got him in the door and into a bed. And in short order, it usually got him a warm meal. After an hour or two, his pain would be gone, he would feel better, and he’d be ready to go home.

I have often wondered where someone like Slim lives. One evening, Denton Roberts and I were sitting behind the nurses’ station. For whatever reason, the conversation turned to Slim, and Denton told me about the time he had picked him up under a bridge. It had been midsummer, and Slim had constructed a lean-to of cardboard boxes. Apparently, based on the litter surrounding this impromptu abode, canned beans and Ripple wine had been his sustenance for several days. On another occasion, he had been picked up in someone’s garage, where he was sleeping on a ratty cot between two broken-down lawn mowers. The owner of the house had provided
this shelter in exchange for the few odd jobs Slim was still able to perform.

I had no idea what he did when it was really cold. Apparently he had some friends who would provide a place to stay until he made them mad or started a fire in the basement, and then they’d kick him out.

We tried everything with Slim: social services, charity organizations, and on many occasions, detox. We even had him committed to a mental hospital once. But nothing worked. It was never very long before he ended up back in the ER.

And here he was on his way in again tonight. We were busy, but it shouldn’t take too long to evaluate Slim and get him squared away. Now this is where I had to be careful. When medical students or first-year residents rotate through the ER, I have to constantly remind them that even our “regulars” get sick, and you have to be vigilant in your assessment of them, as with every patient. Maybe more so. I have to remind myself of that as well. The temptation, of course, is to blow them off as “just the usual” and move on to the people who
really
need your help. Sometimes that approach can be disastrous. It had proved disastrous for another of our ER regulars, Faye Givens.

Faye was a middle-aged woman who had visited our ER on a frequent basis for years. Her complaint was always “nerves,” and by the end of her visit, she would invariably ask for “a sleeping pill.” Sometimes a simple Tylenol tablet would suffice, and she would happily go on her way. At other times, she would become adamant about receiving a shot for her condition, becoming quite loud and disruptive. To my knowledge, she had never been diagnosed in our ER with any serious condition.

One evening she came in by ambulance, complaining of her usual “nerves.” This time, however, she added the complaint of a severe headache, pointing to her forehead. Dr. Canty, one of my younger partners, was on duty, and like the rest of us, he knew Faye very well. His cursory exam did not elicit any bothersome findings, and he was prepared to try giving her a Tylenol and send her home.

He instructed Lori, on duty that particular evening, to do just that. She went to Faye’s room but immediately came back to the nurses’ station, her medicine cup still containing the small white tablet.

“I’m just not sure about Faye tonight,” she told him. “Something’s just not right about her. Maybe you’d better take another look at her.”

Dr. Canty stopped what he was doing and looked at her. A part of him responded to Lori’s concern, trusting her proven judgment. A small cloud passed over his previously clear decision, causing him to second-guess himself momentarily. But this quickly passed, and he blew off this interruption. He had seen Faye on many occasions and it was always the same—no emergency, no serious medical problem. It was always just a disposition dilemma—how to get her out of the department with as little trouble as possible.

Yet he respected Lori. Partly to placate her and partly to dispel any remains of that bothersome cloud, he walked over to where Faye was sitting on the edge of her stretcher. Her head was hanging, lolling slightly from side to side. Even this posture was part of her usual behavior.

“Faye, how is that headache?” he asked her.

“Doc, it’s killin’ me. Like somethin’ is stickin’ in the middle of my head. Can’t you give me somethin’ for it?” she pleaded.

He reached out and took her head in his hands, once more making sure her neck was completely supple. It was. And then he looked again at her eyes. Amazing! They were crossed, and she was able to hold them that way! That took a real effort. Her look was comical, and he tried desperately to suppress a chuckle.

An Academy Award–winning performance,
he thought to himself.

“I’ll be right back,” he told her, walking out of the room and over to Lori.

“She’s fine,” he said, a tone of finality in his voice. “Go ahead and give her the Tylenol and let her go.”

Reluctantly, Lori did as instructed, and Faye was soon on her way home.

Two days later, she returned to the ER, dead. Her autopsy revealed
she had a large tumor pressing on the ocular structures in the front of her brain. That was what had caused her eyes to be crossed, and was what killed her.

I was behind the closed curtain of room 5 when I heard the clicks and wheezes as the automatic ambulance doors opened. Then I heard Denton as he confirmed his destination with Lori. “Room 2?” he asked her.

“Yes,” she answered. “That’s fine.”

“Ooooooooo!”

It was a moan I would recognize anywhere. Slim.

“Oooooooo! My belly!”

I finished giving instructions to the patient in room 5, pulled the curtain aside, and stepped out. Turning back to the middle-aged man on the stretcher, I said, “Go ahead and get dressed. A nurse will be right with you.” I pulled the curtain closed behind me.

Denton had deposited Slim on the bed in room 2, and Lori was taking his temperature. My eyes caught Slim’s and he furtively looked away.

“BP’s 110 over 70,” Denton informed me. “And his pulse is about 90, but a little irregular. He looks okay to me,” he added, holding the EMS clipboard in his hand while I signed the bottom of the transport sheet.

“Okay, Denton. Thanks.”

He pushed the stretcher out of the cubicle and moved toward the nurses’ station while I stepped into Slim’s room. Lori had replaced the blood-pressure cuff in its holder on the wall and was attaching two electrodes to his chest, connecting him to the cardiac monitor.

“114 over 72,” she told me, turning on the monitor and then making a note on a paper towel that had been hastily placed on the countertop. “No fever. 98.4.”

“Oooooooo! Doc, do somethin’! It’s killin’ me!”

The monitor came to life, and its
beep-beep-beep
drew my eyes to the screen mounted on the wall over his head.

I thought immediately of Rita Flowers.

Rita was a recently graduated RN, rotating through the ER as part of her hospital orientation. She was a bright young woman, but the jury was still out as to whether she had the judgment to be a good critical-care nurse. At this point in her career, she was of course quite green, and very naïve.

On one particular day, she had the good fortune to take care of Slim. He had come in by ambulance with his usual complaint of abdominal pain. She was quite concerned by his writhing, vociferous demonstrations, and she hurriedly checked his vital signs and connected him to his monitor. Her obvious concern was not lost upon him.

She had hastily stepped across to the nurses’ station and grabbed the nearest available physician.

“Doctor, you need to come and see this man!” she pleaded. “Now!”

The ER doctor had looked over her shoulder and readily identified her patient.

Turning back to the chart on the counter, he said, “It’s okay, Rita. I’ll be there in a few minutes.”

She stood there, not knowing what to do. She looked around for help, but everyone seemed busy. Racing back to his cubicle, she glanced at the cardiac monitor. It was now nice and regular. That was good.

Slim continued to moan, his eyes closed, his hands clutching his belly. Slowly one eyelid crept up, and he waited for his opportunity.

Rita turned to the countertop by the side of the stretcher and began making some notes. Slim slowly reached up to his chest and grasped one of the monitor electrodes attached there. He jiggled it forcefully and cried out in agony.

“Ooooooo!” he yelled, rolling from side to side.

Rita looked at him, and then instinctively at the monitor on the wall. All kinds of wavy lines were crossing the screen! She had never seen anything like it before. What was she supposed to do? Call a code? And then suddenly there was a nice, quiet, regular rhythm. Slim’s moaning stopped. Rita breathed a sigh of relief.