Tales from the Emergency Room (7 page)

No Parking Card, No Degree

In order to park at Strong Memorial Hospital one needed a card to gain entrance to the lot. We did not receive our actual diplomas at the graduation ceremony, but were instructed to pick them up at the Registrar’s Office. We were all packed and ready to leave when I went to get my diploma. There, I was informed that I could not pickup my parchment until I had turned in my parking card which I knew was already packed in a suitcase somewhere. So I would have to send that back and have my degree mailed to me. My father’s comment on all this was, “I wish I had known that all you needed was a parking card to get your MD degree.” I think he had the money he had spent in mind.

 
The Post-Graduate
 
Training Years

The Emergency Room

The Emergency Room was to me by far the most exciting place to work in the hospital. One never knew when certain skills would be needed. Indeed, many ways of doing things would be invented (or reinvented) on the spot. The main drawback to emergency medicine in my view was the lack of follow-up with the patients. They would be treated and discharged, never to be seen again or disappear into the hospital for further treatment. Rarely was there time to check on a patient later, but I would sometimes hear what his or her ultimate fate had been.

Of course, there was one advantage; when quitting time came one could leave the problems of the day behind while unfinished cases would become someone else’s problem. Usually, but not always!

Under The Sink

Many were the men and women who arrived in the ER in a state of inebriation. Often, they were brought in by the police, sometimes so drunk as to be semiconscious. However, one never knew—other problems such as diabetic complications could mimic drunkenness. So it was important that all of these individuals be thoroughly examined and properly diagnosed, even the ones who were regulars. There was not room in the ER to place these people in beds and even then it would have been unsafe to do so. Therefore, a place was set aside under the sink in the largest utility room where the patient, on a cushion, would not injure himself and could be observed frequently.

Naturally, after leaving the ER after a hard day’s work one did not expect to encounter the same patients the next day. One afternoon and evening I had had an especially difficult time with a woman who was intoxicated. She was eventually placed “under the sink”. As I left to go home I must have expressed my exasperation with this patient to the people coming on shift.

When I arrived for my shift the next morning I was greeted by several of my “colleagues” who were standing by the wheelchair in which they had placed my by now very hung over patient. Thus, I would have to deal with the lady for several more hours. They thought that this was very funny and eagerly awaited my reaction. They were not disappointed since now I was even more exasperated with them than with the patient. My friend eventually was able to leave the ER and thankfully did not return that evening!

If I Am Found Dead . . .

Behind the staff doing their paperwork in the original Roosevelt Hospital Emergency Room was a large plate glass window overlooking a fairly large waiting room. On my first day as a resident in medicine assigned to the ER, while I was finishing up a chart, I noticed a commotion in the waiting room. It revolved around a woman who seemed to be having a sudden problem of some sort. She was taken into the nearest room, the minor OR, and settled on the table there. The nurse in charge directed me, specifically, to attend to the patient. I did a thorough exam after listening to her complaints and then went over things again because I could not find evidence of a medical problem. I assumed that was because of lack of experience on my part. I reported my lack of findings to the head nurse. We agreed that the patient should remain in the waiting room for a time so that she could be observed. Shortly thereafter as I checked through the glass window I saw that the woman was writing on a long slip of paper which, I later found out, she kept in her bra instead of her pocketbook. What was she doing I inquired of the nurse. Barely able to contain herself, the nurse explained that the patient recognized me as new to the ER and she had gone into her usual act when she spotted a new doctor. She was adding me to the list of all the medical personnel including nurses who had also not found anything wrong with her. It was labeled, “If I am found dead, the following people killed me.” The first name on the list was the very same nurse I was working with that evening who had worked in the ER for many years. Over the next few years, I got to know this “patient” quite well. She often said her rosary in the waiting room and we would sometimes walk together to services in the church across the street. I also saw her often seated at her card table on the streets around the church selling chances for various church fund-raisers. We never discussed her list.

St. Patrick’s Day

The busiest day and night of the year in our Emergency Room was, without question, St. Patrick’s Day. The alcohol problems were legion, but the trouble resulting from brawls was more serious. It was possible to slip on the blood in the hallway, often mixed with rain water and melting snow. There was suturing going on non-stop and occasionally people would have to be prepared for the operating rooms upstairs. Needless to say, the “under the sink” crowd was large and it was a busy/hectic scene.

The Egg

When I was an intern we were allowed to watch and help out in the step-down area next to the ER. One evening while I was there a man and woman were sent to the area to have a very delicate procedure done. It seems that during sex play the woman had inserted an uncooked egg straight from the refrigerator into her partner’s rectum (I am not making this up!)

The egg got stuck, still intact, which accounted, I suppose, for the odd gait that the man had upon arrival in the ER. Naturally, the egg had to be removed and so I learned a technique which luckily I never had to use. A very careful administration of a dose of olive oil was delivered into the rectum in question and then the egg was punctured, the contents of the egg spilled out and the egg collapsed. The oil prevented any injury to the surrounding tissues as the egg shell broke apart and was expelled. At the time I thought that this was the cleverest thing I had ever seen and, of course, the whole idea was terribly funny to me as well. The patient quickly recovered his dignity and left. I hope he never tried this again. If he had used a hard-boiled egg, extraction of the foreign body would have been more difficult.

The Non-Alcoholic

In the same area where the egg episode took place some people spent days while the hospital operated at 100% capacity. My job one day was to take an admission history and perform an admission physical exam. I introduced myself to a very distinguished looking middle-aged man whose excellent color did not immediately suggest illness. His admitting diagnosis however was cirrhosis of the liver. The reason this man stands out in my memory is apparent from his history. He was an executive high up in the railroad industry and, I gathered, did most of his work at lunch and dinner with other businessmen. He actually admitted to having a fair amount of alcohol to drink as a normal part of his day but did not consider himself to be an alcoholic. Lunch always began with several drinks. During most afternoons there would be more drinks in business offices and boardrooms. He dined out virtually every night on business with several drinks, wine and after-dinner drinks. He rode in the bar car on his commute to the suburbs, and there was always a nightcap at home. Heaven knows what happened on weekends! However, as part of his talk with me he noted that he had never been drunk and that no one had ever seen him function below top notch because of alcohol. It occurred to me that there was always a minimum level of alcohol in his blood stream, and that his liver was ruined having to continuously process the chemical. In reality, no one knew what he was like without his alcohol dose. He eventually died in the hospital from bleeding esophageal varices, a direct result of his liver disease.

The Wrong Way Ride

Whenever the police found a new physician in the ER, they would zero in on him (not usually her) in order I suppose to have a little fun. One evening I was called to go in the patrol car to an intersection nearby because of a report of a man lying in the street. I knew the location was north of the hospital but was alarmed and then really frightened to find that, indeed, we were going north, on Ninth Avenue which is one-way going south! It was a fast ride during which I rode with my feet on the dashboard. Then, to get to the scene we drove west on an east-bound street. When we got there, the “patient” had gotten up and wandered off, but many people had witnessed this so there really had been the potential for trouble. Ever after, as I got to know New York City’s Finest, I was reminded of this ride and my reaction to it. Everyone except me thought it was hilarious, but I was just happy to have lived through it unscathed.

Illegal Turn

Getting to know the police did have benefits, however. About three years after the story above, I turned off of the West Side Highway at 72
nd
Street because the traffic ahead of me on the Highway was at a standstill. It was the end of another busy day for me. I was still wearing my hospital whites and driving my little red Volkswagen. I knew all the reasonable routes around traffic jams on my way to and from work. At the stoplight, I made a left onto Riverside Drive to continue my trip north. I was immediately pulled over for making this (unknown to me) illegal turn. About half-way through his review of my “error” the officer stopped, peered closely at me and began to chuckle. He had identified me as the “Doc” known for his one-way rides. Then he bawled me out, but he didn’t give me a ticket and we had a friendly little chat before I went on my way. Never again did I make that wrong turn and, over the years, I have often thought of this brush with the law.

No MD License Plates

In January, 1962, while I was still working in the ER, a monumental snowstorm swept down upon New York City. I remember especially how quiet the area around the hospital became for several days. There was so much snow that the City actually closed. No unnecessary vehicles were to be allowed into Manhattan. And, I had to get to the hospital! However, I did not yet have my New York State License and therefore I did not have MD plates (my father always maintained that MD stood for “muddled driver”). I would be wearing my hospital whites driving into the City but I did not have a good way of proving that I actually was a doctor. Finally, I took my framed medical diploma off the wall at home, put it in the trunk of my car and set off through the snow from New Rochelle, NY. I actually made it into upper Manhattan before a police officer stopped my car. I explained the problem but he looked skeptical. So, I got out, opened the trunk and produced the diploma. He looked it over closely and broke out laughing. He let me continue on my trip, warning me that I might be stopped again. I wasn’t and I arrived on time at the hospital. Having driven around in the snows of Rochester, NY for eight years, I also arrived without a weather-related mishap.

The Speeding Ticket

Some people are just naturally thick, hopefully only occasionally like me. On my way to work while I was still in the ER, a New York State trooper pulled me over on I95 near New Rochelle because I was speeding. By then my car had MD plates and I was dressed in my hospital whites. After the usual license examination and talk about my transgression, the trooper asked me where I was going so fast and why. He asked me two more times and finally gave up and wrote me a ticket. I swear it was weeks later as I was driving my usual route to the hospital (within the speed limit) that I suddenly realized that he was trying to get me to explain that I was on my way to an emergency call at the hospital so that he could give me a warning and not a ticket. I really couldn’t blame him for ticketing somebody so dense. He probably remembered my name in case he ever had health related dealings with me.

The Fishing Expedition

In the ER there was a black bag in reserve to be taken along on ambulance calls. There was also a reserve vial of Demerol to be used for pain control if needed. The Demerol was, for security reasons, not kept in the bag but handed to the doctor on his way to the ambulance. One very hot midsummer night not long after I began in the ER a call came in for a woman in labor. The patrol car collected me after I had placed the Demerol in my white jacket pocket and we proceeded, along with an ambulance, to the tenement to see the about-to-be mother. The apartment was on the fourth floor in a walkup building and, on my way up the stairs, I realized that there was a police officer on every landing. (Later I understood that this was for my protection.) The apartment building was very old and the rooms were immense with high ceilings. All of the windows were open to the courtyard because of the summer heat. Save for the improvised labor room, there was only one piece of furniture to be seen, a straight-backed chair next to a window. I draped my jacket over the chair and went to examine the patient.

Her room was draped with white sheets and she lay in labor on a mattress on the floor. There were children everywhere, some peering over the sheets, very interested in what was going on. The woman was howling. I conducted an exam and decided that there would be time to transport her to the hospital for the delivery.

When I went to retrieve my jacket it was nowhere in sight. As I looked around, an officer handed me my coat with the narcotic vial still in the pocket. The officer patiently explained to me that the chair on which I had hung my jacket was near an open window, that the apartment house tenants routinely fished (literally with fishing poles) items out of such locations. Had my jacket remained where I had left it, it would soon have disappeared Demerol and all. Another mistake I never repeated.

We finally all arrived out on the street where I heard the ambulance attendant say to the patient who was still howling away as she was lifted into the ambulance, “You should close your mouth and cross your legs and if you had done that in the first place this never would have happened!”