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CHAPTER 1

Part I

ER and EMS: Inside the Double Doors

Patients say things to us that are far better than comedy writers might ever imagine. When we try to repeat those stories, we may lose a little in translation, but clearly, patients do not always speak the same language as health care workers. Sometimes the health care providers themselves botch communications in creative ways. Whether the double doors lead to the back of an ambulance or the entrance to the Emergency Room, we all share "say what?" moments that are confounding at the time, but provide fodder worth sharing with our coworkers after the call (or ER care) is over. Here are a few conversations between people who thought they were on the same page only to find they were not even in the same book.

I'm Sorry ... Could You Repeat That?

"Is that going to hurt?" I am inches from your arm with a sharp needle that is about to pierce your skin and enter your vein. There are nerve endings that are invisible to the naked eye; we know they are in there, but we cannot see them. Sometimes we hit one, sometimes we go through the vein (especially if you jump, wiggle, flail your arms, and scream). We are not trying to cause harm, and a fast IV is better for both of us.

I am very good with needles, and I can get an IV where other folks might not even attempt it. After 11 years in a Detroit Trauma Center, I can get blood out of a rock, and almost all past coworkers have at some point asked me to get an IV for them, including the resident physicians. I will pull the skin tight, enter with lightning fast speed, draw the blood, and have the line connected and taped down before you can say ouch, even if it is in your foot. I am that good, but no matter how high my skill level, I am stabbing you with a sharp instrument.

Yes, it is going to hurt.

*
Mikey began working in EMS long before me and remained long after I left; he is still running around in ambulances scraping people up off the roads and coming into their lives at the most inopportune moments. Mikey says he has more "Huh?" — "Say what?" incidents than he cares to admit. Maybe it is a sign of the times.

On his first call of the day, Mikey responded to an unknown medical complaint in an apartment building. Sitting on the edge of her bed was a female patient who burst into tears when she saw Mikey walk into her room. When asked what was wrong, the patient responded that she had double vision and could see two Mikeys standing in front of her. Trying not to laugh at what struck him as a comical visual image of sudden personal cloning, Mikey and the patient concluded that a trip to the hospital was probably in order.

As Mikey and his partner were tucking the patient into the stretcher with fashionable EMS blankets, there was a sudden knock on the door, and the patient asked Mikey to see who was there. When Mikey stuck his head out the door, a "frumpy little man" who lived down the hall looked up at Mikey and demanded to know what was going on. Temporarily dumbfounded, Mikey repeated, "What is going on?" Most folks who see two uniformed men wearing radios, carrying a medical jump kit, pushing a gurney piled with heart monitor, equipment, and an oxygen tank can figure out what is going on without a lot of explanation. To his credit, Mikey gathered every bit of self-control and resisted the temptation to utter what he really wanted to say, as this unknown visitor wanted an explanation for the 911 emergency: "Sir, we are having a Tupperware party, and we were just about to start burping our lids. Want to join us?"

*
ER tech Campbell relates a triage moment representing too many confounding exchanges with patients as staff tried to determine the patient's chief complaint. A young man walked up to the desk and told Campbell the patient's girlfriend "burned" him. Campbell asked if it was with water, oil, lighter fluid, curling iron, the stove, or ... The man shook his head repeatedly while looking down, repeating, "My girlfriend burned me!" Becoming exasperated, Campbell thought if she could not determine the mechanism of injury (cause of the burn), perhaps she could establish the location of the injury. "Sir, can you tell me where you were burned?" Without raising his eyes, the young man said, "On my Hmm-Hmm," and the skies opened to rain down realization on this normally perceptive young woman. The fellow was trying to obtain treatment for the sexually transmitted disease he believed his girlfriend had given him.

*
A local firefighter/paramedic tells me about a conversation witnessed between his partner Chrisand a patient. A 30-year-old healthy female without any medical history and taking no medications complained of chest pain, insisting that she was having a heart attack. The advanced critical care paramedics connected the woman to a 12-lead EKG monitor (same as in the emergency room), assessed her vital signs, and tried to reassure her that she was not having a heart attack.

Incensed, the woman insisted, "I AM having a heart attack! I am a nursing student, so I KNOW what a heart attack feels like!" As the medic in charge of her care, Chris engaged mouth before brain, telling the patient, "Yeah, well ... I took a cooking class once, but that doesn't make me a chef."

*
Medic Jeff S. traveled by ambulance to a home in a large mid-Michigan city, dispatched for a patient who could not "make water." Upon arrival, Jeff attempted to obtain the chief complaint from the patient's wife, who insistently repeated the same words without clarification. Although Jeff rephrased the question several times, he always got the same answer, and still had no idea what the wife was trying to convey.

Thinking literally, Jeff tells me, "I had no clue. I thought, "What is she talking about? You just turn on the faucet to make water." During his brief assessment, Jeff discovered that the patient could not pee.

*
I worked with Jeff S. for many years in a very small town. He was an EMS guru from the big city, responsible for organizing and stocking our ambulances. If Jeff was the medic in charge and attending a patient during transport, more often than not, Jeff declared that we did not carry bedpans in the ambulance.

One expected sequelae of a motor vehicle crash (MVC), especially with females, is the sudden urgency to void (pee, urinate, or "make water"). MVC patients routinely find themselves sporting a cervical (neck) collar, secured with straps to a long backboard to protect the spine (neck and back). Maneuvering a patient onto a bedpan in a moving ambulance is unsafe. If someone is unstable and must urinate, we have told them to go ahead and relieve themselves, and we will clean it up later. Better to be a little wet than permanently disabled.

On a particularly long transport of a stable patient, I searched through the storage compartment under the ambulance's bench seat for a blanket, finding a well-hidden but familiar pink plastic basin. Females usually cannot ride five hours without emptying their bladders, so I retrieved the bedpan for our patient. I assisted the patient (it was the nurse in me), and felt quite satisfied at providing one small comfort to a very grateful woman. As I tried to place the bedpan on the floor of the moving ambulance while preventing the generous contents from sloshing all over our immaculately clean floor, I understood why Jeff preferred not to provide bedpan service. Score at the end of the transport, Jeff: 1, Rookie: 0.

*
Mike A. relays a conversation between himself and an alleged seizure patient at the local jail. Seizure is a common complaint for inmates activating their medical "get out of jail free" card, so one never knows what to expect. Many who find themselves incarcerated prefer the warm blanket, footies, turkey sandwich, juice, and friendly nurse in the emergency room to a cold jail cell and often-colder demeanor of attending officers. In short, many medical complaints from jailed complainants have no sound physiological basis.

This particular exchange is truly a head scratcher, worthy of repeating, and provides sound social commentary. In the process of medically assessing the jailed "seizure" patient, Mike came across multiple marks on the patient's skin indicating a history of IVDA (intravenous drug use).

Mike: "Ma'am, what are these needle marks from?"

Patient: "Heroin."

Mike: "How much do you use?"

Patient: "I spend $800 a month on it."

Mike: "Wow that's a lot; you must have a good job."

Patient: "No, I spend my Social Security check on it."

Mike: "You're very young. Why do you get Social Security?"

Patient: "I'm disabled."

Mike: "Why are you disabled?"

Patient: "I'm chemically dependent [on Heroin]."

Your tax dollars at work.

*
Laurie S.W. is an amazing nurse with a no-nonsense demeanor that required some personal adjustment and adaptation from me when I started working in my first trauma center. Once I understood Laurie, we had the type of verbal exchanges that might seem hostile, but they were all in good fun and helped us deflect stress. The good-natured bantering also helped us to keep from expressing our frustrations in negative and unproductive ways, like toward the patients or staff who sent us teetering too close to the proverbial emotional "edge."

Years ago, patient names were neither disguised nor confidential, so to organize ourselves in the ER, we wrote the patient's last names on a dry erase board. One afternoon when things were not so busy, and the patients, who had nothing to do but wait for tests and watch the staff buzz around, noticed the odd exchanges between Laurie and me. Every half hour or so, Laurie or I would point to the dry erase board and the other would acknowledge, often with a laugh, protruding tongue, or a hand gesture involving limited numbers of fingers.

The family in the corner of the room had the best view, and called me over expecting an explanation of our shenanigans. Because I had been interacting with those folks for several hours, I knew they had a sense of humor and might appreciate the private joke.

Laurie had written "STFU" on the dry erase board in large letters. Unable to stand the suspense any longer, the family had to know what the acronym meant, and I was happy to share the secret. STFU, as most folks know in this day of texting acronyms, an obscene translation of the phrase, "Shut The Front Door!"

Can you feel the love?

*
Serina L. rendered me speechless with something I had never considered before (and they say there is nothing new under the sun). A young female seen in the ER for complaint of abdominal pain had the normal workup, which included a pregnancy test. Not surprisingly, the pregnancy test was positive.

When told by the nurse that she was pregnant, the patient — who was completely shocked and baffled — replied, "But I thought you couldn't GET pregnant when you had Chlamydia!" Um ... are sexually transmitted diseases a form of birth control? I must have missed that day in nursing school.

*
When a nurse or medic administers narcotics without using the entire vial of medication, another staff member must corroborate appropriate disposal of the remainder of the vial. We call the disposition of excess narcotics "wasting." In the ER, you may hear the summons for a staff member to come to the locked medication room as, "nurse to the med room for a waste, please."

Sometimes the harried nurses spew twisted utterances, providing cause for a double take. Overheard in a large city ER, where drug abuse and stress levels were both quite high: "Nurse to the med room to get wasted, please!" Oops. Do-over?

*
"Do you want to see this?" is a question posed by patients who are sure you will not believe the color or consistency of what they have produced from their nose, rectum, stomach or elsewhere. We really do not want to see. We believe your mastery of language is sufficient to describe the suspicious emergence, thank you.

We will even put your vibrant and animated description in quotes throughout our nurses' notes to assure a relatively precise accounting of what ails you and where it came from. Please do not fish it out of the toilet so we can send it to the lab, as we can only use hospital-gathered specimens. I always advise patients to leave whatever they have gathered at home.

Gallows humor prevented me from following that advice.

After returning from a teaching deployment in Alaska, I paid a visit to my internal medicine doc, Seth P. I had known Seth and his wife, Monica, all through their residencies (she must have been the smarter of the two, as her specialty was Emergency Medicine). Seth was quite a prankster, and once whispered, as we stood at the foot of an unconscious patient's bed, that he and Monica had separated. When I told Monica I was sorry to hear the news and explained the conversation, she rolled her eyes and said, "That's OK, I tell people he's dead."

Paybacks are Heck, Bubba.

I sat across from Seth at his office desk, uncomfortably clutching a paper bag. Apologizing, I told Seth I knew how unpleasant samples could be regardless of our professionalism, but I had something to show him. I slowly opened the bag, revealing a ratty paper towel wrapped item. Spending a few moments explaining that this was something I had never seen before, I slowly pulled the wrapping from around the medical specimen cup. Inside the clear cup, Seth and I could both see something small wrapped in crumpled toilet paper.

Preparing Seth further, I said, "This is a stool sample. I carried it all the way back from Alaska for you." I placed the cup in front of him; scrunching his face in preparation for something completely disgusting, Seth asked if he needed gloves. I shrugged and watched him gingerly unscrew the cap of the specimen cup. He hesitated, so I took the cup from him, dumping the contents onto his desk; he jumped.

Pulling the tissue from around the "specimen," I revealed the object I'd carried all the way back from Alaska. The cup held a thumb-sized glass jar marked "Stool Sample" and contained a miniature wooden stool (the four-legged variety used to sit upon).

Gotcha, Sethie.

*
Triage nurses hear a good number of intriguing stories, and sometimes generally mundane complaints produce the most interesting results. A woman presents to triage complaining of impending labor. However, because she doesn't have an obstetrician or a positive pregnancy test, and she doesn't look pregnant, she may not be rushed to the labor and delivery suites. Patients fitting this description come to the triage desk quite often and with predictable results. They usually suffer from some type of female problem, go home with a prescription for Motrin, and live happily ever after.

A nurse friend of mine tells about the day this normally uninteresting type of patient complaint had an O. Henry (or Edgar Allen Poe) ending. The triage nurse generated the appropriate chart, and escorted the patient to a "girl room" (breakaway bed with stirrups). The nurse gave the woman a sterile urine cup, asking her to provide a sample, and then put the cup on the bedside table.

The patient's primary nurse ran the urine test proving the patient was not pregnant. Following protocol, the nurse set the patient up for a pelvic exam, and waited for the doctor. When the doc exposed the woman's private parts, he saw the labia closed by three large safety pins, with what appeared to be remnants of raw chicken protruding between the pins.

I have no further comment.

*
Dee S. and I worked together in a city Trauma Center with 75 beds, and on a busy day, more than 100 patients. Some weeks we ran out of the rolling multi-fold dividers intended to provide visual barriers between patients doubled together in single rooms. Trying to maintain appropriate patient care with too many patients and too little privacy challenged us daily. Dee was city savvy and saw the comical side of everything, often sprinkling snippets of humor like anti-stress fairy dust.

Assisting patients with transportation was one of Dee's duties. Some folks arrived to the ER via ambulance and legitimately had no way to return home. Other times, folks wanted the "free" ride, insisting they had no family or friends, denying the multiple visitors at their bedside (or asleep in the lobby) during their stay. The patients who knew and regularly used the "free ride" system often proclaimed, "And don't you give me no bus voucher, I know you can order me a cab. I want my cab. I don't ride no bus."

Dee relates a "head shaking, what the heck?" moment.

A young male in his twenties walked into the ER under his own power, through the metal detectors, and up to the triage desk where Dee met him. The young man told Dee he'd visited the ER yesterday, and though he had requested bus tickets home yesterday, he did not get them ... yesterday. He wanted them now.

Dee: "How did you get home [yesterday]?"

Patient: "I walked."

Dee: "How did you get here today?"

Patient: "I walked"

Dee: "So you walked back here today just to get bus tickets to

go back home?"

Patient: (silence).

(Continues…)

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Excerpted from "More Confessions of a Trauma Junkie"
by .
Copyright © 2012 Sherry Jones Mayo.
Excerpted by permission of Loving Healing Press, Inc..
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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