Текст книги "Dude, Where's my Stethoscope?"
Автор книги: Donovan Gray
сообщить о нарушении
Текущая страница: 3 (всего у книги 14 страниц)
PART TWO
Ma and Pa Kettle: The Rural Years
Ch-ch-ch-ch-changes
In the fall of 1990 my good friend Barb the hairdresser announced she had found the perfect girl for me.
“Yeah, right, Barb,” I replied dryly. I’d witnessed some of her previous matchmaking attempts. Not good.
“No, trust me, you’ll like this girl! She’s really cute and she’s got a great sense of humour!”
“Okay, if you say so. What does she look like?”
“Five-foot-four with light brown hair and greenish eyes.”
“What does she do?”
“She’s an elementary school teacher.”
“Sounds promising. What’s her name?”
“Janet.”
After a few phone calls, Jan and I scheduled a blind date at a nearby Perkins restaurant. The day before we were to meet she came down with a wicked flu. She considered cancelling, but ultimately curiosity got the best of her and she decided to proceed. Aside from her having shaking chills (plus Barb and my buddy Raj unexpectedly sliding into our booth halfway through the meal to mooch some fries and inquire how the date was going), everything went pretty well. We agreed to continue seeing each other.
Meanwhile, back at the ranch, I had come to the conclusion that although I enjoyed working as an ER physician in Winnipeg, I wanted to see what life was like on the other side of the urban/rural divide. Several telephone calls and reconnaissance trips later I accepted a position as a family doctor in a small town in northern Ontario. I shipped a few moving boxes, loaded up my MR2 and headed east in July of 1991.
Making an abrupt transition from a city with a population of 600,000 to a remote hamlet of 6,000 is much like doing the legendary Polar Bear Dip – extremely shocking at first (what do you mean there’s no Starbucks here?), but then you quickly grow accustomed to it. Then you die of hypothermia. Kidding!
My new gig was a bona fide cradle-to-grave family practice. Technically it was a solo practice, but I shared ER call and hospital responsibilities with a congenial group of four other family doctors plus a general surgeon. On a typical weekday I would do rounds on my hospital inpatients early in the morning, perform a couple of minor procedures in the emergency department, and then go to my office for a full day of scheduled appointments. When the office wrapped up I would usually return to the hospital briefly to check on my inpatients’ progress and review the results of any tests I had ordered earlier. On weekends I’d do my regular hospital rounds first and then spend some time at the local nursing home.
Being responsible for my own inpatients was a deeply rewarding experience, but I won’t pretend it was all rainbows and lollipops. For one thing, it meant visiting the hospital 365 days a year unless I happened to be out of town. In addition to commanding a significant chunk of my time, it paid poorly. Despite these drawbacks, there was one very big plus: it allowed me to care for my patients when they needed me most, i.e., when they were sick enough to warrant hospital admission.
Every Wednesday and some weekend days I’d be on call for the ER for 24 consecutive hours. In order to accommodate my ER obligations, my receptionist always booked a lighter office on Wednesdays. This allowed me time to shuttle back and forth between my clinic and the emergency department. The ER tended to be reasonably quiet between 6:00 and 8:00 p.m., so most evenings I’d be able to sneak back to my apartment for supper and a power nap. After that I’d return to the ER and see outpatients until midnight. The void between midnight and 8:00 a.m. was highly unpredictable and ran the gamut from wonderful to bloody awful. On a good night there’d be no outpatient visits after midnight and I’d be able to get a solid six or seven hours of shut-eye. More often than not, though, people would continue trickling into the department well into the wee hours and my sleep would get hopelessly fragmented. Once in a while I’d get no sleep at all. That gets old very fast. It’s hard to face the new day when it feels like your head is screwed on backwards.
Aside from missing the action at my old ER in Winnipeg, I was pretty much hooked on my new job right from Day One. There was something immensely satisfying about sending an acutely ill patient from my office to the ER, meeting them there to start treatment, admitting them to the medical ward, rounding on them daily until they recovered and then having them follow up with me back at the office. It was like being an office-based practitioner, an ER physician and a hospitalist all rolled into one. Of course, it’s not like I invented that particular enterprise. Most rural (and some urban) generalists have been playing endless variations on that theme ever since Og fell off the first stone wheel and got rushed to the Healing Cave back in 20,000 BC.
Jan and I conducted a long-distance relationship during my first year in Ontario. In July of 1992 we tied the knot and she joined me in my northern adventure.
Devolution
For the first few months after we got married, whenever I was telephoned at home in the middle of the night to go see patients in the emergency department Jan was the epitome of concern. The instant I hung up she would ask me if I had to go in. I’d fill her in on the details as I stumbled around in the dark looking for my clothes. Before I left she’d always say she hoped it wouldn’t be long before I was back. When I eventually returned home and crawled under the covers she’d wake up and murmur something appropriately sympathetic in my ear. Ah, those were the days.
As time passed she gradually stopped asking what I was being hauled out of bed to go and see, but she never failed to say, “Do you have to go in, honey? That’s too bad.” It became a comforting little ritual.
One night I answered the phone at 3:00 a.m. and glumly listened to the ER nurse explain that she needed me to come see some intoxicated yo-yo who was going to require a truckload of stitches. When I hung up Jan rolled over and said, “Do you have to go in, honey? That’s too…zzzzzzzzzz… .” As I lumbered out the door I thought, “Uh-oh. Things are definitely slipping.”
After that she completely quit waking up for those maddening nocturnal phone calls. I can’t really say I blame her – it’s probably a sanity-preserving defence mechanism. It certainly preserves her sleep! You could nuke the house next to ours and she’d snore right through it, guaranteed. Some nights I’m recalled to the emergency department three or four times after midnight. Our alarm clock invariably goes off 20 minutes after I’ve limped into bed for the final time. Jan usually sits up, stretches luxuriously and announces, “What a great night! You didn’t get called once!”
“Great night,” I croak incoherently.
A few days ago our prehistoric bedroom telephone finally gave up the ghost, so we replaced it. The new phone rings like a klaxon from hell. Last night I was on call. This morning Jan didn’t look quite as well-rested as she usually does.
“I don’t like that new telephone,” she complained. “It woke me up!”
I had to work hard to keep the grin off my face.
The Big Smoke
Not long after we moved to northern Ontario, Jan and I decided to spend a romantic weekend in Toronto. We planned to fly out after work on a Friday evening and attend The Phantom of the Opera, then spend the next day shopping. Saturday night we’d have supper at a cozy restaurant. On Sunday afternoon we’d pack up and fly home.
First we made our flight and hotel arrangements. Next we phoned the theatre to purchase tickets. They cost a small fortune, but we’d heard so many wildly enthusiastic reviews about the show we would have gladly paid double the asking price.
The last thing we needed to organize was our Saturday night soirée. Being recently displaced prairie folk, neither of us had the faintest idea where to go in Toronto for a good meal. We solicited advice from our co-workers and one of Jan’s colleagues recommended a restaurant he and his wife liked. Jan asked if I’d need to wear a suit or jacket and was assured dress pants with a shirt and tie would be more than sufficient. We called the restaurant and made reservations for 7:00 p.m. on the Saturday.
A couple of weeks later we packed our bags and left for the airport to begin our much-anticipated weekend in the Big Smoke.
After checking into our hotel we spruced up a bit and caught a cab to the theatre. The lobby was packed with excited people. Through one of the doors nearby I glimpsed a portion of the stage as well as the first few rows of seats. I surveyed our tickets: row K, centre. This is going to be great – 11 rows from the stage!
We joined one of the queues and slowly inched our way to the nearest door. I handed the usher our tickets. He looked at them, frowned deeply and passed them back to me.
“Is something wrong?” I inquired.
“Sir, these are for row K, upper balcony. This entrance is for the seats on the main floor.” He said “upper balcony” like it was some kind of STD.
I quickly re-examined the tickets. Of course he was right.
“Which line should we be in?” I asked.
“Over there.” He pointed to a long line at the far end of the lobby. Jan and I mumbled apologies and shuffled over to the proper line-up. Eventually we made it to the balcony. I looked down at the stage and was disappointed to see the view wasn’t that great. Oh well, 11 rows from the front of the balcony will still be okay. When we got to row K I motioned to my wife and started to edge in.
“Wait a minute, this isn’t right,” said Jan. “This row is full.”
“Really?” I backed out.
“Look,” she continued, her eagle eyes fixed on the dark nether regions at the rear of the theatre. “Right now we’re in the main balcony. Our seats are in the upper balcony!”
I thought back to what the usher downstairs had said. Jan was correct. Row K? More like K2! Our seats were going to be so remote, we’d need Sherpas to find them. We steeled our jaws and continued on our quest.
A couple of postal codes later we arrived at row K in the upper balcony. It was one row from the wall at the very back of the theatre. The only people behind us were a few pimply high school kids. They were busy having a lively discussion about the latest Guns N’ Roses album. I turned my attention to the stage. From our vantage point it was about the size of a shoebox. A well-decorated shoebox, but a shoebox nonetheless.
The show began. The people onstage looked like ants. Singing ants! What a concept! But why were they so fuzzy? It suddenly occurred to me that in our haste to get to the show on time I had left my glasses back at the hotel.
“I can’t see a thing!” I complained to no one in particular.
“Shh!” the high school students chorused.
A few minutes later an usher came by hawking programs. I was tempted to ask him if he also sold high-altitude oxygen bottles, but I knew Jan would slap me silly if I did.
“Do you sell binoculars?” I asked.
“Yes, sir,” he replied. “Only $15 apiece.”
“I’ll take a pair, please.” He took my money and ran.
I inspected my new purchase in the half-light. It looked like something you’d get with a McHappy Meal. When I removed the shrink wrap, one of the eyepieces fell off and rolled down the aisle. A Good Samaritan picked it up and returned it to me. I jammed the plastic lens back into place and tried focusing on the stage. If anything, the el cheapo binoculars made it look even farther away. Now the people were no bigger than grains of sand. Singing grains of sand! Gosh, what’ll they think of next?
“Hey man, binocs. Cool! Can I try?” asked one of the acne victims behind me.
I tossed the useless binoculars over to him.
“You can keep them,” I grumbled. I closed my eyes and settled in for a several-hundred-dollar nap.
The next day we went shopping. I like shopping about as much as the next guy – which is to say, not at all. I basically spent most of the day muling Jan’s multiple purchases around the mall. When I started getting blisters on my palms I pleaded for mercy and escaped back to the hotel. Jan returned a few hours later. Her Visa card was so hot it glowed.
Later that evening we started getting ready for our dinner date. At 6:55 a cab dropped us off at the restaurant. As we hung up our coats we agreed we were definitely indebted to Jan’s colleague for his tip. The place looked classy and the food smelled delicious.
I walked up to the maître d’ and said, “Hi! We have a seven o’clock reservation.” He stared at me intently, much like a scientist studying an unusually freakish lab specimen. Uh-oh. “Under Gray,” I added nervously. He cleared his throat, but didn’t say anything. The suspense was gruesome. “Is there some kind of problem?” I finally blurted out.
“Oh no, not at all,” he said. “But perhaps monsieur would like to wear… zis?” He reached into a nearby closet and pulled out a threadbare brown corduroy jacket. I recoiled in horror. Oh, no. The house jacket – the jacket loaned to charity cases who have the gall (or stupidity) to show up at formal restaurants in inappropriately casual attire. I briefly wondered what Quincy scribbles on his coroner’s report when someone dies of embarrassment.
I was about to politely decline his offer and slink out of the place like a mangy cur when three couples sauntered in and lined up behind us, effectively blocking our escape route. I noted miserably that each of the men was wearing a high-end Harry Rosen suit. I recognized the cut because I happened to own one. The problem was that these guys were wearing theirs, whereas mine was hanging uselessly in a closet about 800 kilometres away.
“Sh-sh-sure, I’ll wear the jacket,” I stuttered. I motioned for him to pass it to me. I was hoping to get it on before anyone else noticed some jackass had tried to defile the dress code.
“Let me help you weeth zat, monsieur,” he oozed. He then proceeded to hold the arms out for me. I tried not to flinch as I slid my arms in. Behind me I heard one of the Rosen triplets gasp. My cheeks started burning. I snuck a peek at Jan. She looked ill. I finished wriggling into the jacket and straightened up. It was about three inches too short at the wrists. Hey, look at me – I’m Jethro Bodine! I had a frightening vision of the maître d’ poking around in his carnival closet of terror for a jacket that would fit me better while more and more guys straight off the cover of GQ joined the line-up behind us.
“Fits great,” I squeaked. “Where do we sit?” Jan and I marched to our table in lockstep. I was certain everyone we passed was gaping at me and whispering, “Is that guy really wearing the house jacket? What’s this place coming to? Let’s get the hell out of here!”
The food tasted like sawdust.
On-Call Gall
“Once more unto the breach!”
– King Henry in William Shakespeare's
The Life of Henry the Fifth
It’s Saturday morning in the ER. I’m about to emerge from my foxhole at the main desk and go on point again. Born to Cure… .
My first patient of the day is Rocky. He moved to our little duckburg only a few weeks ago, yet he’s already racked up an impressive number of alcohol-related ER visits. Rocky lives at “no fixed address” and his home telephone number is “not applicable.” This time he’s been delivered to us because someone found him crawling around on his hands and knees trying to round up a herd of invisible bugs. I guess everyone needs a hobby. I drain the last of my Tim Hortons coffee, rrroll up the rim (please play again!) and walk over to his cubicle.
Rocky is horizontal on the stretcher. He’s a dishevelled-looking fellow in his late 50s. His salt-and-pepper hair shoots out wildly in all directions and he’s sporting a week’s worth of gnarly stubble. It looks like his nose has been broken a few times. He’s heavily doused in that best-selling cologne, Eau de Stale Booze. I think he’s sleeping.
“Hi Rocky, I’m Dr. Gray.”
No response.
“Wake up, Rocky.”
He yawns widely and rolls onto his side. Ack! Plumber butt much?
“Rise and shine, Rocky!”
His eyes pop open.
“Whaddayawant?” he grunts. Communication! Hey, now we’re getting somewhere. Things are looking up already.
“My name is Dr. Gray. I’m here to see if you’re okay. Are you able to sit up?”
Sitting up doesn’t pose much of a challenge to most people, but the Rock Man makes it look like it should be included in the decathlon. He plants his elbows firmly by his sides and starts throwing his head forward in a series of jerky attempts to lift his torso off the stretcher. At the same time his legs scissor up and down vigorously. I fail to see how that’s going to help the situation. Perhaps Mission Control sent different messages to the upper and lower halves of his body. After about half a minute of flailing he manages to get himself upright.
“Thanks, Rocky. Now I’m going to – ”
“Wait!”
“What’s wrong?”
“I think I’m gonna be sick!”
“Hang on, I’ll get you a basin right away!” Too late – he leans over the wastepaper basket beside his stretcher and does a humongous technicolor yawn: “Huuurrrraaaalp! Huuurrrraaaalp!”
There’s no sign of blood in the stuff coming up. Big Macs and Pop Tarts, yes, but blood, no. I hand him some towels and canvass the area for a basin.
Does everyone else’s workday begin like this?
While an aide cleans up Rocky, I proceed to the next cubicle. In addition to looking like he’s just been keelhauled, patient number two is wearing the same cologne as Rocky. Talk about bad luck. This isn’t going to be another one of those days, is it?
“Hi, I’m Dr. Gray. How can I help you this morning?”
“I wanna go to detox. I don’t have any money, so I’ll need a ride, too.”
“Okay, we’ll see what we can do. When was your last drink?”
“Last night.”
“How much did you have?”
“Lots.”
“What were you drinking?”
“Lysol and Orange Crush.”
“Anything else?”
“Shaving cream.”
Mamma mia.
I ask switchboard to contact the intake worker at the nearest available detox centre. Rocky’s still barfing up a storm, so I order some IV fluids, Gravol, Valium and thiamine for him before moving on to the third patient. According to the chart, his name is Harley Wayne Gacy. If he’s not a serial killer, I’ll eat my socks.
“Hi Mr. Gacy, I’m Dr. Gray. That’s a very interesting Charles Manson T-shirt you’re wearing! Who would have guessed that chainsaws could be so versatile? So, how can I help you today?”
“I need prescriptions for OxyContin, Talwin and Ritalin. And something for my nerves, too. And my parole officer says I have to get these disability pension forms filled out right away… .”
¡Ay, caramba!
My fourth patient presents with a stellate scalp laceration sustained in a booze-induced inward pike off the back of a moving pickup that occurred sometime around midnight. I'm surprised he waited so long to come in – it looks like an asteroid collided with the back of his skull. I give him a complimentary reverse yarmulke and get busy with my needle driver and forceps. While I sew him up we listen to the not-so-soothing strains of Rocky repeatedly breaking the 11th Commandment (Thou Shalt Not Upchuck on the Floor of the ER). Half an hour later my crash test dummy is looking human once again. Antibiotic dressings, a tetanus shot and a trip to the radiology suite follow in short order. Not long after that he's exiting stage left. Goodbye Mr. Bloody-Head! No more Olympic asphalt-diving, please! I catch up on my charting and order some IV Maxeran for Rocky.
The receptionist drops another fresh batch of outpatient charts on the ER desk and whispers, “Incoming!” That immediately triggers a harrowing flashback to the time I travelled up the Nung River deep into the heart of Cambodia in search of a brilliant yet almost certainly insane colonel who…wait a minute – that was Benjamin Willard, not me. Oops. Sorry about that, folks. Anyhow, the triage note on patient number five reveals he’s here today because for the past few months he “just hasn’t been feeling quite himself.” I know from previous ER encounters that he has a tendency to ramble. This time I’ll try to take control of the interview by avoiding open-ended questions.
“Mr. Filibuster, I’m going to ask you a series of questions and I’d like you to just answer yes or no, okay?”
“Okay, doc.”
“Have you lost any weight recently?”
“When I was a young ‘un living down in Oklahoma back in the Dirty Thirties… .”
Can I get a swig of that grape Kool-Aid?
Patient number six:
“Hi, I’m Dr. Gray. How can I help you today?”
“I’m from out of province and I’ve run out of my birth control pills. Can you give me a refill?”
“No problem. What are they?”
“I’m not sure. Something-21.”
“Most of the brands come in packs of either 21 or 28.”
“Actually, it might have been Something-28.”
Swing low, sweet chariot… .
Patient number seven is another prescription refill. The last one was a bit of a gong show, but I’m confident things will go more smoothly this time.
“I’m Dr. Gray. How can I help you?”
"I’m here in Ontario on vacation and I’ve run out of my pills. Can I get some refills?"
“Sure. What medications do you take?”
“I don’t know the names.”
“Did you bring your bottles with you?”
“No, but I can tell you what the pills look like. There’s four white ones, a pink one and a wee little yellow one.”
Just take me now, Lord… .
Despite having an entire pharmacopoeia at my disposal, Wookiee-like noises continue to emanate from Rocky’s cubicle. Eventually I throw in the towel and admit him to the medical ward. The rest of the morning continues on in a similar vein. The afternoon’s no prize, either. Around suppertime the nurse supervisor informs me the waiting room is finally empty. Thank God! I was about to change my name to Sisyphus. If I’m lucky, things will stay quiet for a little while. I go home to eat with Jan.
By the way, we never say the Q-word out loud in our department. Every ER worker on the planet knows the instant you make a comment about how quiet it is, a jumbo jet full of ventilated preemies will crash land in your staff parking lot. Probably right on top of your car. That’s just the way ER karma rolls.
It is now the witching hour. I’m two-thirds of the way through my 24-hour shift. I think I’ve treated close to 20 people since I got back at 8:00 p.m. Thankfully, I’m down to the last one. According to the triage note, she’s a previously healthy 60-year-old who has been experiencing minor cold symptoms for a week. Her vital signs are all normal. Hmm. Something tells me this case isn't going to make it onto House. Oh, well. One last person to see, and then I get to crawl into bed for a while.
“Hello, Mrs. Coryza, I’m Dr. Gray. How can I help you tonight?”
“Well, I’ve had this runny nose and cough for a week now, so I figured I should come in and get checked.”
“Have you had any fever?”
“No.”
“Have you been short of breath?”
“No.”
“Are you coughing up any sputum?”
“No.”
“Any other symptoms?”
“No.”
“What made you decide to come in tonight?”
“I just thought it was about time I got some penicillin for it.”
Her examination is completely benign. Since I know what she is expecting from this visit, I carefully explain to her why using antibiotics to treat viral upper respiratory tract infections is not appropriate.
She takes a moment to mull it over, then adroitly changes her tack.
“Can I have a chest x-ray, then?”
She doesn’t need that either, but since she obviously has no intention of leaving this department empty-handed, it’s a compromise I can live with. I write up the requisition.
“The x-ray department’s closed now. Come back on Monday morning and they’ll do it then.”
As I turn to leave she says: “You know, my son should probably see you, too.”
I’m crestfallen. More business. Precisely what I do not need at this hour of the night. I don’t recall seeing anyone else in the waiting room, though.
“Where is he?”
“At home. Can you stay here while I go and get him?”
“Well, that depends. What’s wrong with him?”
“He was in a car accident.”
“A car accident? What time did it occur?”
Oh, it didn’t happen today; it was about a month ago.”
“A month ago?”
Yes. His chiropractor says he’s got whiplash, but I think we should get another opinion.”
“You want a second opinion on a Saturday at midnight?”
“Yes, I’m wondering if maybe he should be getting some other type of treatment.”
There are a number of ways I could respond to this request, but most of them would probably earn me a stern reprimand from the College of Physicians and Surgeons.
“Why don’t you bring him in on Monday morning when you come for your chest x-ray?” I suggest sweetly.
“Will you be here Monday?” she asks.
“Yes.”
“Okay, that sounds good! Good night, doctor. By the way, you should try to get more sleep – you look really tired!”
It’s Got to Be in Here Somewhere
Recently a middle-aged woman took a tumble while jogging on a dirt road. She fell with her arms extended, so her palms and wrists took the brunt of the impact. In ER lingo that mechanism of injury is known as FOOSH, or “fall on outstretched hand.” Hey, don’t look at me – I’m not the one who comes up with these half-baked acronyms. Anyway, after going home and removing as much of the gravel from her wounds as she could, she presented to our emergency department. Once I was satisfied there were no other significant injuries I applied a topical anaesthetic gel to her abrasions and scrubbed all the dirt out.
“How’s that?” I asked her when I was finished.
“Much better, although it feels like there might still be something in here,” she said, pointing to the middle of her left palm.
“Okay, I’ll send you over for an x-ray.”
Fifteen minutes later I went to the radiology department to look at her films. To my chagrin, there was a pebble-sized object in the centre of her left hand. It appeared to be right on the surface of the skin. How the dickens could I have missed such an obvious foreign body? I returned to the ER with the x-rays and carefully reassessed her hand, but I couldn’t find the offending piece of gravel. After a brief discussion we decided our only option was to go in and retrieve it.
Using her films as a map, I infiltrated her left palm with local anaesthetic, made an incision and started looking. No mysterious particle popped into view. I did some blunt dissection. Nothing. I extended the incision radially and continued the search. Nothing but blood. Several minutes passed. Where the hell was it? Every so often my patient would ask, “Find it yet?”
“Not yet, but it’s got to be in here somewhere.”
After what seemed like an eternity, one of the x-ray techs walked into the room.
“Oh, there they are,” he said. “I’ve been looking for these films all over the place. The radiologist wants to read them before he leaves.”
“Could you please ask him if he’d mind waiting for a couple of minutes? I’m using them to help me locate this foreign body.”
“What foreign body?”
“The one in her palm,” I replied, and pointed it out on the film.
“Oh that,” he said. “Didn’t you get our last memo? We’re not using the old arrow-shaped marker to show the spot where the patient has the foreign body sensation anymore. The new marker looks just like a little pebble.”
Semantics
A while back I saw an ER patient who was complaining of a persistent cough. It appeared to be nothing more than the common cold, but because it had been going on for a few weeks I elected to send him for a chest x-ray. Once the film was processed I went over to the radiology department to look at it. It was completely normal – no pneumonia, cardiomegaly, congestive heart failure, pleural effusion, pneumothorax or anything else of significance. I went back to the patient’s cubicle to wrap up the interview.
“Well, Mr. Kowalski, I don’t see anything on your chest x-ray.”
“Nothing at all?”
“That’s right.”
“Okay. Thanks anyway, doc.”
I thought he looked at me a little strangely as he left, but I figured I was just being paranoid. I moved on to the next patient.
An hour later I was back in the radiology suite reviewing another film when one of my colleagues showed up. He pulled out the chest x-ray of the patient with the cough I had seen earlier.
“I already looked at that one,” I said. “It’s normal.”
He seemed taken aback.
“What did you say to him?” he asked.
“I told him I didn’t see anything on his x-ray.”
He started laughing.
“What’s so funny?” I asked.
“He called me at my office in a big panic saying he had just had an x-ray at the hospital but the doctor who had ordered it didn’t know how to read it.”
“What made him say that?”
“You told him when you looked at his x-ray you didn’t see anything.”
Needless to say, ever since that day I’ve changed the way I tell patients their x-rays are normal.
Rocky II (The Sequel)
It’s yet another Saturday morning and I’m back for more punishment in the ER. Where did all the people in the waiting room come from? Five minutes ago the joint was empty. Maybe spontaneous generation does exist after all.
My leadoff patient is none other than the infamous Rocky. Once again he’s toxic and on the verge of hurling. Whenever he shows up like this I usually end up admitting him for a day or two to help him dry out. Things are a little different today, though – there are only two empty beds left in the entire hospital. If I admit him to one of them I’ll be snookered if I need beds for sicker patients later on in my shift. To the best of my knowledge, Rocky has never had any potentially dangerous alcohol withdrawal problems such as the DTs or seizures. After careful consideration I make an executive decision to turf him to a detoxification centre. I ask the ER charge nurse to have switchboard locate the closest detox centre’s intake worker.
“Aren’t you forgetting something?” she asks.
“What?”
“They won’t want to take him the way he is now.”
True enough. Detox centres don’t like their alcoholics drunk and barfy; they like them dry and stable. Most of them will only take “clients” who have been alcohol-free for at least a couple of days.
“Yeah, I know that.”
“So how are you going to convince them to take him?” she persists.
“I’m going to stretch the truth a little bit.”
She looks at me askance as her index and middle fingers carve a pair of scare quotes into the air above her head.
