*Ring, ring*
“Thank you for calling Podunk General Hospital, Nail Salon, Tire Repair and Crawfish Hut. This is the Emergency Department. How may we alleviate your pain and suffering today?”
“Hey AD, it’s Paramedic With Potential. Stand by for patient report.”
Shit.
“Hang on a sec, PWP,” I stall, scrambling for a pen and scratch pad. “Okay, whatcha got?”
“83-year-old female, took a spill at the casino. She, uh, sustained a pretty decent little hematoma to her forehead, and about a two centimeter laceration…”
“Is that her singing A Little Less Conversation in the background, PWP?”
“That would be affirmative, AD,” he answers.
“Is this lady drunk?” I ask.
“Tore up from the floor up,” he confirms, and I can just see him grinning and rolling his eyes. “Anyhow, neuros are intact and vitals are stable. She’s just gonna need a few stitches. See y’all in five minutes.”
I hang up the phone with a chuckle and go inform the nurse. Housekeeping hasn’t come to clean Room One yet, so I quickly wipe down the bed and change the linens. I pull the curtains between Bed One and Bed Two, and explain to Drunk Girl’s mother that they’ll soon be sharing the room with another patient. For her part, Drunk Girl doesn’t show much in the way of reaction. After six hours and two liters of fluids, she’s almost sober enough to go home.
That is, if she’s even looking forward to going home. Her mother was pretty livid when we called and told her where her daughter was, and what she had been doing.
A rousing rendition of Suspicious Minds heralds the arrival of PWP and his patient. He and his partner are trying – with only middling success – not to laugh like hyenas while they push a stretcher loaded with the sweetest little grandmotherly lady you could ever imagine, belting out at the top of her lungs, “We can’t go on togetherrrr, with suspicious miiiinds….and we can’t build our dreeeaaams, on suspicious miiiiinds…”
She’s even got the Elvis lip curl going on. And she is, just as PWP said, as drunk as a boiled owl.
“Bed One, guys,” I laugh, pointing. “Lemme get a chart and I’ll meet you in there.”
PWP and his partner are shifting her over to our ER stretcher by the time I get back to the bedside, and she grabs PWP by the cheeks and plants a big, wet, sloppy kiss squarely on his lips.
“Looks like somebody had tee many martoonis,” I observe wryly. “So what’s the rest of the story?”
“Too many glasses of white wine,” he corrects. “She swears she’s never been drunk before -”
“Never more than one glass of wine with dinner, in all my years,” she interjects solemnly, one hand over her heart.
“Anyhow,” PWP continues, “she and a neighbor were at the casino, playing slots for most of the afternoon. They got to playing blackjack, and she got off her stool to go pee. When she did, she pitched forward and whacked her head on the dealer’s table.”
“And we were winning, too!” chimes in her friend, standing in the doorway. “I was showing her how to play blackjack, and she was up almost a thousand dollars…”
“And the waitresses were good about keeping your wineglasses filled, huh?” I nodded knowingly, ushering the neighbor to a seat at the bedside. “Especially when you were winning?”
“Crooked bastards!” the old woman crowed indignantly, then belched gently and swung into a soulful rendition of In The Ghetto.
“You’ll have to excuse her,” the neighbor apologized, mightily embarrassed. “In twenty-six years, I believe this is the first time I’ve ever seen her drunk.”
“Rotten sumbitches prob’ly spiked my wine,” fumed the old woman. She lay her head back against the pillow and bellowed, “THOSE COCKSUCKERS!”
Her neighbor blushed like a tomato.
“More likely that she drank more than she realized. They keep the booze flowing pretty freely, but they tend to serve a little more often if you’re winning big, especially if you tip well,” I explain with a chuckle. “So why don’t we start with you telling me what your friend’s name?”
“Marion LeBleu,” the neighbor furnishes. “Her husband has Alzheimer’s, and I help her take care of him. We decided to have a Lady’s Day Out, so we hired a sitter…”
“One second,” I interrupt, holding up a hand. I go about gathering a history from Mrs. LeBleu, trying to sandwich in some information gathering between rambling, drunken non sequiturs and rousing renditions of Hound Dog, complete with gyrating hips.
At least, as good an imitation of Elvis The Pelvis as lying on a hospital bed will allow.
I learn that Miss Marion is a retired LPN and “ain’t gonna tolerate no fuckin’ Foley catheter,” that she didn’t lose consciousness after she hit her head, that her only medical history is hypertension and high cholesterol, and that she does not smoke or drink alcohol to excess.
Well, before today, that is.
When I ask her about previous surgeries, she slurs, “Hadda a hyshereckomy forty years ago.”
“That’s all?” I press. “Otherwise, you still have all your original parts?”
“Beshides my Eucharist and ovaries,” she leers drunkenly, throwing a credible bump and grind. “They took out the factory, but they left the playground.”
I stifle a giggle, and ask, “Any allergies?”
“Aish inhiti…imbibi...inhibitibi…”
“ACE inhibitors?” I finish, and she nods drunkenly. “Tongue swell up on you, did it?”
“Like a dick on wedding night,” she confirms, winking lewdly. “Not like I coulda got one in my mouth with my tongue all schwelled up…”
Her friend looks like she wants to crawl under the bed. Me, I’m doing all I can to keep a straight face.
“Weeeellll, okay then,” I laugh. “The doctor will stitch up your cut, and we’ll probably start an IV and draw some blood, give you some fluids and get a skull x-ray, just in case.”
Back in the nurse’s station, Doogie Howser Doc looks at me expectantly.
“Minor head lac, no loss of consciousness,” I report. “Drunk as a skunk, but she’s oriented. No significant medica
l history. Want me to order a skull film and start pushing the fluids to her?”
“Is she on blood thinners?” Doogie wants to know.
“Nope.”
“I’ll go check her out,” he yawns and stretches, “but let’s do a head CT instead. She is in her eighties, after all. What room is she in?”
“Just look for the sweet little old lady belting out My Way and doing those Elvis karate moves,” I advise. “You can’t miss her.” Doogie chuckles and saunters across the hall as I type the orders into the computer.
Five minutes later, he’s back. He fishes a sawbuck out of his pocket and slaps it on the counter. “I’ve got ten bucks in the blood alcohol pool,” he announces. “I say it’s between 180 and 190. Who’s in?”
“I’ll take some of that action,” chimes in Thin Anemic Nurse. “I say it’s at least 220.”
“Nah,” I scoff as I throw my ten onto the pile. “I believe her when she says she’s never been drunk before. I’d say 140, tops.”
“What are you guys doing?” comes a curious voice from the doorway. Roentgen Boy, the radiology tech, is standing in the hall, pushing a wheelchair.
“Head CT on the little old lady in Bed One,” I tell him. “We’re taking bets on her blood alcohol. Ten bucks will get you in.”
“You guys are pathetic,” he snorts derisively, shaking his head. A few minutes later, the chorus of Viva Las Vegas fades down the hallway as RB wheels her to the CT scanner.
“Ladies and gentlemen, Elvis has left the building,” Doogie intones solemnly, earning a giggle from Thin Anemic Nurse.
“What was that she was saying when he was wheeling her past here?” she asked.
“I believe she called Roentgen Boy a ’sexy little studmuffin’.”
“Roentgen Boy?” she asks incredulously. “Hey Doc, I wanna change my bet. Her BAC has got to be higher than 220. Put me down for, oh…280.”
Her blood alcohol comes back fifteen minutes later. It is 139.
I rock.
**********
“Okay, the Doc says you can go,” I announce, holding out the chart and indicating where he should sign.
“Did they ever figure out why he was so faint and dizzy?” wonders Skanky Girlfriend. “Why did his blood pressure drop so low?”
“Probably all the illegal drugs in your system. You may want to pay attention to the lines in your discharge instructions that say ’stop abusing drugs and seek substance abuse counseling’,” I advise.
“But I don’t use drugs!” he protests innocently.
“Yeah, that’s what you told me when the ambulance brought you in,” I say, suppressing the urge to roll my eyes. “Here’s some free advice; next time you overdose, it’s a good idea to refrain from lying to your caregivers.”
“Well, I meant to say I’m not a heavy user,” he amends.
“Here’s a clue, Sport,” I tell him tiredly. “Any time you have to be hauled to the ER in an ambulance because you can’t stand up without passing out and your blood pressure is sixty over Taiwan, whatever put you in that condition is classified as ‘heavy’ use.”
“Well, I only smoke a little weed now and then,” he lies. “Nothing else, I swear.”
“Dude, your urine drug screen came back ‘yes‘. Now sign here and go home.”
**********
“Howdy, Amber,” I sigh tiredly. “What brings you in to the ER this time?”
I’m really not all that fatigued; just tired of seeing Amber in our ER. And her kids. And her husband. Sisters, too. It would be much easier to rationalize their abuse of the system if any of them were ever, you know, sick.
“I’ve been nauseous for the past three days,” she moans, switching her Doritos and Coke to her left hand as I wrap a blood pressure cuff around her right arm.
“Any vomiting?”
“Not until today,” she answers, taking a swig of her Coke, “but I puked twice today. I think I’m getting dehydrated.”
“Your body is seventy percent water,” I assure her. “You’re not going to get dehydrated from two vomiting spells.”
“Yeah, but I’m afraid I’ll get dehydrated,” she argues.
“Are you still nauseous?” I ask as I write, from memory, depression/anxiety, fibromyalgia and unspecified herniated lumbar discs in the block for medical history.
“Real bad,” she confirms. “I can’t keep anything down.”
“Then whose chips and Coke are those?” I ask pointedly.
“Mine,” she says defensively. “It’s the only thing I can keep down when I’m this sick.”
Fiery Habanero Doritos and a fucking carbonated beverage. Who woulda thunk they’d be so effective at calming a queasy belly?
“Any allergies?” I ask, and this time I am unsuccessful at masking my disdain.
Not that I tried all that hard.
“Look, all that shit’s in my chart!” she snarls. “Can’t you just pull it up on the computer?”
“We don’t have computerized charts,” I smile, “so humor me.” I try to keep it friendly and non-threatening, but judging from her reaction, my fangs are starting to show.
“No drug allergies,” she sighs, “no medical problems, either. Except for my nausea, whenever we can get that taken care of.”
Wait a minute. No medical history?
“I thought you took Wellbutrin, Soma and Tramadol,” I remember. “So what are you taking those for?”
“Well, just for my depression, anxiety and fibromyalgia,” she answers dismissively. “Plus, my doctor put me on Xanax, too.”
“Just in case you forget,” I chide, “depression, anxiety and fibromyalgia are classified as medical conditions.”
Well, at least two out of three.
“Look, why don’t you just put me in a room and give me a shot of Phenergan?” she sighs with an air of martyrdom. “If I had wanted a lecture, I’d go home to my mother.”
Excellent idea.
“Sorry, we don’t have any rooms available,” I tell her with no small degree of satisfaction. “You’ll have to sit in the waiting room until one opens up.”
“You tell me that every time,” she spits, “and every time, people sign in after me and still go back to a room first!”
“That’s because the policy is ‘worst come, first served’. I can’t help it if people come in who are sicker than you. If waiting time is that much of a factor, you need a restaurant, not a hospital.”
“You don’t think I’m sick?” she recoils in righteous indignation. She turns to the clerk for support. “He doesn’t think I’m sick!”
I say nothing, but my face betrays my opinion.
“Admit it, you think I’m not sick!” she challenges. “Answer me, chickenshit!”
“I’ll tell you what I think,” I say through gritted teeth. “I think nothing you’ve ever been here for constitutes an emergency. Nothing. I think you’ve been to this ER more in the last month than I’ve been to the ER in my entire life, and I’ve only had health insurance for the last ten years of my forty on this Earth. I think I’m wasting my time having this conversation with you, when I have legitimately sick patients who need my help. If you want medical attention sometime today, Go. Sit. In. The. Waiting. Room.”
She looks at me with a shocked expression for a moment, then stalks to the waiting room in a huff, muttering under her breath.
For my part, I walk back to the nurse’s station, toss the chart savagely onto the desk, and beat my head repeatedly against the counter until the urge to kill has passed. The ward clerk timidly peeks in the door and clears her throat.
“What?” I ask in exasperat
ion.
“Her records are flagged,” she answers meekly. “The business office says I’m supposed to ask her about making payment arrangements. What should I do?”
“Go out to the waiting room and ask her about payment arrangements,” I say, as if to a backward child. “How much does she owe?”
“Over ten thousand dollars, all for ER visits over the past six months. All her contact information and addresses are bogus, too. Am I supposed to be asking her for payment before she’s been seen by a doctor?”
“I don’t know, and I don’t really care,” I groan. “Wait until we can put her in a room and Doogie gives her a look-see. Then ask her about her bill.”
“I ain’t going in there asking for money,” Timid Clerk vows, summoning some backbone. “She’s already pissed off.”
“So bring her an ER Satisfaction Survey,” I suggest, “and tell her to staple a fucking check to it before she mails it in.”
**********
“Mr. Johnson, I need a urine sample from you,” I remind the man in Room Four. Slow and steady, short sentences, no big words. That seems to work best on drunks.
“S’okay,” he smiles agreeably, just as he did the last four times I asked.
“Now,” I say, holding out a male urinal. He blinks at it stupidly, then looks back up at me.
“Already pished in one,” he slurs.
“No, you pissed all over the floor. I need you to put your penis in the urinal this time, and let loose.”
“My penish?” he repeats, confused.
“Your dick, Mr. Johnson,” I sigh, my patience wearing thin. “Whip it out. Stick it in the urinal. Take a piss.”
“Hold the yernel fer me,” he requests, digging both hands down the front of his pants.
“Not happening, buddy,” I say quickly, grabbing his arms. “I’ve seen your aim. Look,” I sigh, “do you think you could piss in a specimen cup if I help you to the bathroom?”
He drunkenly nods, swaying unsteadily on his feet.
Great. At least there’s a floor drain in there.
I help him stagger to the bathroom, hold him up while he fumbles to pull his pants down, then carefully sit him on the toilet.
“Here’s the cup,” I tell him, placing it in his left hand. “Do your business.”
He ponders for a moment, then decides, “Need shum privashy. Gotta shy bladder.”
Where was your need for privacy when you pissed all over my floor, the supply cabinets, and our infant radiant warmer?
“Okay,” I assent grudgingly. “I’ll step outside. I’m gonna put the lid to the cup right here on the sink, okay? When you’re done, just screw the lid on and leave it on the sink. Got that?”
He says nothing, just fumbles somewhere beneath his shirt tail, presumably looking for his dick.
“Mr. Johnson. Put the lid on the cup when you’re done. Don’t piss on my floor again. Say you understand.”
“I unnershtan,” he says proudly, saluting me with the -still empty, thankfully – urine cup.
I step outside and close the door behind me, and wait for what seems like an eternity. A banging on the emergency exit door draws my attention, and I trot to the end of the hall to let in the security guard, back from our food run.
I walk back to my post outside the bathroom door, only to find Mr. Johnson standing next to the bed in Room Four, pants still around his ankles. A streak of shit is smeared halfway up his back.
While I’m trying to decide whether I should help Preston Johnson wipe his ass, or just abandon the effort and let him sit in it, an indignant voice asks from the just-vacated bathroom, “WHO SHIT ALL OVER OUR TOILET AND DIDN’T EVEN BOTHER TO FLUSH IT?”
Ditzy Ward Clerk’s angry query is accompanied by the sound of a flushing toilet, followed soon thereafter by a sound that is entirely…different.
Whoooooooooeeeeeeeeeesssssshhhhhhh…BOOM!
The door swings open, and we peek fearfully inside to find Ditzy Ward Clerk, standing there covered with the eruption from a veritable shit volcano. She is coated from head to toe in shit and tiny clumps of pulpy toilet paper. The only part of her that isn’t brown is the whites of her eyes, and they’re as big as saucers.
There is shit in her hair. There is shit on the floors. There is shit on every visible surface.
There is even shit on the ceiling, radiating outward from around a still-sealed urine cup lodged in the ceiling tiles.
I pull on gloves, tiptoe gingerly into the bathroom and pull my long-awaited urine sample out of the hole in the ceiling. DWC’s decon shower can wait five minutes. I’ve been waiting for this piss for three hours.
Apparently, when you drop a sealed urine cup in an industrial toilet, take a massive tequila-fueled dump in the toilet on top of said urine cup, and then flush the whole mess, it builds up some back pressure.
Considerable back pressure.
Who knew?
