Emergency! (14 page)

It was 3
A.M.
We had emptied out the ER and were looking forward to a few hours of relaxation. One of our nurses was sitting at the triage desk sorting through eighty charts from the preceding twenty-four-hour period. As she was working there, a filthy man appeared and stated that he wanted to be seen by the doctor. He was disheveled and smelled fetid and drunk. The nurse excused herself to fetch a stethoscope, and when she returned seconds later she found the would-be patient standing up on the triage desk, urinating all over the eighty charts.

I was in the ER treatment area and heard her scream. I arrived just in time to hear her reprimanding the gentleman for his lack of self-control. She was obviously upset, and speculated aloud that his parents might not be married. He subsequently told both of us to commit acts that are not anatomically possible, and stumbled out of the ER.

Once we recovered from the shock of the unpleasant encounter, we set ourselves to the task of preserving the eighty urine-soaked charts. We concluded that the best way to dry them was to lay them out one page at a time on all the available ER counter space.

Seven o'clock rolled around and the day-shift personnel began to arrive. I sat in the triage area and watched the expressions on their faces as they entered what smelled like a ballpark men's room. Knowing very well that I would be leaving for home within minutes, I jokingly taunted my coworkers with comments about working in a urinal all day. Then, one of the staff arrived and yelled out to me, “Hey, Doc! There's somebody sleeping in your Jeep.”

I could feel my scrotum contract. My Jeep was a brand-new canvas-top Golden Eagle. I loved that car. I raced into the parking lot. I got to my Jeep and opened the passenger door. Cigarette smoke billowed out. There, stretched out across the front seats of my pristine automobile, slept the drooling, drunken, dirty, urine-soaked body of Mr. 3
A.M.

B. RICHARD STILES, D.O.
       

West Chester, Pennsylvania

T
he fifteen-year-old girl averted her eyes as I entered the examining room. Grandma was fat and paced like a ferret. I had interrupted some passion play and the tension made the room seem smaller than it was.

“I'm Dr. O'Malley, what can I do for you?”

My patient didn't answer.

“Tell him what you here for. Tell him what that boy done to you.”

I thought that my patient was going to throw up, but she began quietly crying. I gently asked Grandma to wait outside, and left her cussing at some paramedics in their ready room. When I returned to the examining room, my patient had stopped crying and was nervously tugging at a shoelace. She wore a T-shirt with
PUBLIC ENEMY
on it. I have all their CDs, and I suddenly felt very old.

My patient was an honors student. Her posture was perfect. She was enrolled in summer school for advanced college-placement credits. Her lower abdominal pain had begun several days ago, one week after her first sexual experience. He was an older boy from around the block that she knew from the neighborhood. The diagnosis wasn't particularly difficult. The disposition was.

I allowed my patient to remain clothed. I sat on a low stool in a far corner of the closet-sized room. I explained to her the intricacies of a pelvic exam—an experience I would need to introduce her to. From her position atop the exam table, she listened politely to my explanations about adnexa and cultures and specula, and gave an occasional sigh. As the conversation turned to infections, she grew deathly quiet and her attention became rapt. For a while she held her breath.

“You know, if you have sex with someone and you don't use a condom, getting pregnant isn't all you have to worry about.”

“I know.”

“Besides syphilis, gonorrhea, and venereal warts, there are other diseases that our … uh, your generation has to worry about.” My patient was silent. “Do you know what disease I'm talking about?”

My patient gasped softly and began to sob. “Yes.” She sniffed. “AIDS.”

“Do you love this guy?”

“I don't know.”

“That's OK.” I asked her to undress and I went for a nurse.

When I finished, the nurse prepared the injection and I found Grandma still simmering. I sat down and offered her coffee. She declined and lit a cigarette.

“Well … she's pregnant, ain't she? Lord Jesus, I know that son of a bitch got her pregnant. You know that he waited for her mother to be at work and for me to be out shopping. He waited for an empty house and got that girl pregnant.”

“She's not pregnant.”

“She's not?”

“No. We did a test.”

“Thank the Lord for that.” She smashed the cigarette out in the ashtray, gave a long sigh, and folded her hands in her lap. She no longer appeared angry, she just seemed tired.

“She has an infection.”

“Gonorrhea?”

“Maybe. Probably. Listen, I know that you're angry, but don't be angry with her. She made a mistake. She needs you now. If you need to be angry with someone, take it out on the guy that did this to her.”

“Can I get him arrested?”

“I don't know.”

Grandma thought for a minute and lit another cigarette. I sipped my coffee and wrote up the chart. The fluorescent lights buzzed noisily overhead and drowned out the din of the Emergency Department down the hall. “Damn fool girl,” Grandma said. “I could've killed her when she told me about it.”

“But she told you anyway.”

“Yeah.”

As my patient walked down the hall, she limped slightly, sore from the gluteal injection. At first Grandma walked behind, oblivious to the girl's gait, but as they neared the exit doors I watched carefully as my patient offered her denim jacket to the old woman. Grandma put on the jacket and gently led my patient by the elbow out the door, into the softly falling summer rain. Then they took each others' hand and walked out. I felt the tightening of goose bumps on my arms and turned back into the fray.

GERALD O'MALLEY, D.O.

New York, New York
 

I
t was a Friday in the summer of 1973 and the gastroenterologists had a new toy: a fiber-optic flexible scope, which allowed for a periscope view of the inside of the colon. It was equipped with a biopsy forceps. They let it be known to the ER staff that they would be willing, even happy, to evaluate and treat rectal bleeding in the ER. In fact, they added an incentive—a six-pack of any domestic beer—for the house officer who recruited an “appropriate” (i.e., insured) patient.

Enter Mr. Simmons. He had blood in his stool, and a GI series showed a polyp in the transverse colon. He was stable, cooperative, and insured: the perfect recruit. Three gastroenterologist attendings and a gastroenterologist fellow performed the colonoscopy in the ER pelvic room. It was not a short procedure, and there was joyful shouting when the polyp was finally located (not exactly where it seemed to be on the X ray, but then again, we were reminded, the colon is a mobile organ). The polyp was snared and gingerly extricated. I held the formalin container as the stool-coated growth was deposited during smiles and self-congratulatory handshakes. The fellow took it up to pathology himself, not trusting the precious specimen to some anonymous orderly.

The pathologist evaluated the “polyp” and issued his report on Tuesday morning. I was alone when I read the formally phrased and very brief report. I knew I'd be buying my own six-pack.

The pathology report said: “Normal grape.”

MICHAEL HELLER, M.D.     

Pittsburgh, Pennsylvania

T
he seventy-year-old female patient had a history of frequent urinary-tract infections. She had a fever and slight back pain, so I ordered a catheterized urine specimen to be sent to the lab. I went on to other patients, but the nurse soon returned and said she had tried to cath the woman but couldn't find her urethra—the opening to the bladder. She had asked several other nurses to help her cath the lady, but no one could find the urethral opening. I decided to help, and went to the patient's bedside. I found an elderly, pleasant woman who told me about the history of frequent urinary problems and told me she was childless.

I examined the woman's perineum and identified the larger orifice of what appeared to be the vaginal vault, and searched above this for the urethral opening. I couldn't find an opening either, but as I looked, some urine trickled out of the vagina. Suspecting a fistula connecting the bladder to the vagina, or an embedded urethral meatus, I decided to look inside the vagina with a speculum. As I readied to do this, however, I noticed something underneath the vagina, on the perineum, and looked closer. I found the patient's vagina and
intact hymen
under what I had assumed was the vagina. I realized that the upper opening she was using as a vagina was in fact the patient's urethra. I asked the woman if she had any problems with sexual relations with her husband.

“Not really. It hurt the first year or so, but it was fine after that.” She had been married for fifty-two years.

CHARLES HAGEN, M.D.

Auburn, Alabama
    

O
n a Sunday evening we received a call from a paramedic who said he was bringing in a woman with some nasal trauma. The patient arrived in the Emergency Department, a gauze pad covering her face. When the gauze was removed, it was noted that her nose had been removed as well—flush with her cheekbones. This included the amputation of both the soft tissues and bony tissue of the nose. The nasal concha were completely visible. Remarkably, there was absolutely no bleeding.

When the patient was asked what had happened, she told the following story:

No longer in love with her husband, she had found, and now loved, another man. She and her lover had gone to her home and explained to her husband that she was leaving and would not be back.

Her husband, who had been drinking, got up silently from the sofa, went into the bedroom, and came back into the living room with a .30 caliber rifle. The husband had the wife tie the lover's hands behind his back and lay him facedown on the living-room floor. The husband tied up the wife in the same fashion. The husband then shot the wife's boyfriend in the rectum, the exit wound nearly blowing off his genitals. The husband then proceeded to lift his wife's head off
the floor by her hair and took a serrated knife and sawed the patient's nose off her face. He flushed the nose down the toilet. The husband then notified the police.

DONALD GRAHAM, M.D.

Boring, Oregon