Aside from an abundance of minor scrapes and bruises, Rob appeared to be all right. Even his nipple rings were intact. The only thing of concern was his left elbow – it was moderately swollen and he wasn’t moving it well. I asked switchboard to call the x-ray tech in. I was feeling a little guilty about the way I had summarily kicked his girlfriend out earlier, so I asked the receptionist to allow her to return so they could sit together while he waited for his films. My conscience appeased, I hunkered down at the main desk in the ER and began my charting.
As soon as his girlfriend arrived they started talking:
“You okay, baby?”
“Yeah, I’m fine.”
“What’d the doctor say?”
“I just need a couple of x-rays, no big deal.”
“Will you need a cast?”
“Dunno.”
“What about one of those shots for, you know, that, like, lockjaw thingy?”
“Naw, I got one of those after I got my tats in jail a coupla years ago.”
“Oh, that’s good. You sure you’re okay, baby? How many times did you roll?”
“Six or seven times, max. Like I said, no big deal. I’ve been in lots of rollovers before. I just walk away from them.”
“Oooh, Robby,” she squealed, “you’re the best!”
Yep, that’s a really important trait to take into account when considering a potential mate – the ability to walk away from rollovers. You just never know when it might come in handy!
Drinking Problem
Several nights ago a 14-month-old boy with a cough was brought to our emergency department. While I obtained the history from his mother, the little fellow happily explored the room. After a couple of minutes he toddled back to her and reached for the half-full cup of Tim Hortons coffee she had been sipping from.
“Eh! Eh!” he grunted.
“Jack-Jack want coffee?” she asked.
“Eh! Eh!” he confirmed.
She handed him the cup. I watched in disbelief as he noisily slurped the rest of the java down. When he was finished he burped loudly, hucked the empty cup onto the floor and wobbled away.
“You let your 14-month-old son drink coffee?” I asked incredulously.
“Oh, Jack drinks whatever I drink,” was her reply.
Blood
At 8:30 this morning a trucker accidentally dropped a large hunting knife on his left foot. The blade pierced the skin and embedded itself deep in the bone. When he pulled it out, a miniature geyser of blood erupted. He tried to staunch the flow with some towels, but within a few seconds they were soaked. He drove his rig to our hospital and limped into the ER. The triage nurse applied a tight pressure dressing and had me paged.
By the time I arrived, the minor trauma room was saturated with the odour of blood. It washed over me in waves as I stitched up the wound. Traces of it clung to my clothes long after the patient departed.
Just as the ghostly scent of blood was beginning to fade from my memory, an industrial accident victim was brought in. He had crushed his right hand between two steel plates. Fortunately no bones were broken, but several of his fingernails had blood trapped underneath them. The nail bed hematomas were causing a lot of pain. To relieve his discomfort I drilled holes through the damaged nails with an 18-gauge needle. The smell of the draining blood gave me a weird feeling of déjà vu.
An hour later a drunken 25-year-old who had just put his fist through a plate-glass window staggered up to the receptionist’s desk. Arcs of blood sprayed from his jagged wrist laceration in perfect sync with his heartbeat. I hustled him into a treatment room and began suturing. After about a dozen stitches the bleeding reluctantly came under control.
My next patient asked me to look at a mole on her shoulder that had recently enlarged. It was multi-coloured, elevated and irregular. She didn’t have a family doctor, so I removed it for her. More molecules of blood escaped into the air.
After the mole excision I went to the dirty utility room to deposit my used scalpel blade and needles. One of my colleagues had just finished a busy lumps-and-bumps clinic, so the sharps disposal container was nearly full. When I opened it I was assaulted by the odour of fresh blood once again.
Our bedroom is bathed in moonlight.
The clock on the wall reads a quarter past midnight.
I’m lying in bed, waiting for the Sandman.
I can still smell blood.
Paralyzed
Tharn - a fictional word used in the Richard Adams novel Watership Down to describe rabbits frozen in terror at the sight of the headlights of an oncoming car.
One night I was working in the emergency department when the nursing supervisor advised me an ambulance had just been dispatched to pick up a teenager who had collapsed. A few minutes later EMS radioed to notify us they were coming in hot with an unstable cardiac patient.
They rolled in with a drowsy 15-year-old boy named Johnny. He had a pulse of 230 and a dangerously low blood pressure. We got him into a gown, administered oxygen and put him on the cardiac monitor.
He wasn’t my patient, but I vaguely remembered seeing him in the ER a few years prior for issues related to an irregular heartbeat. At the time a pediatric cardiologist had strongly recommended Johnny undergo a relatively minor procedure on the electrical pathways of the heart to eradicate the disorder.
“Did you ever get that heart procedure done?” I asked.
“No.”
“Why not?”
“I didn’t want it.”
“Does your heart beat too fast sometimes?”
“Yes.”
“What do you do when that happens?”
“I take these.” He pulled a bottle of heart pills out of his pocket. “I’m supposed to take one three times a day, but sometimes I forget. If my heart’s going too fast I take a few extra. I’ve been doing that a lot lately.”
“Where are your parents right now?”
“I just live with my mother. Why?”
“I’m going to need to speak to her.”
“About what?”
The pills he was on can sometimes trigger abnormal heart rhythms if not taken as prescribed. Using layman’s terms, I advised him that with the current combination of heart disease, unknown levels of cardiac medication in his bloodstream and unstable vital signs, the quickest and safest solution would be for us to provide intravenous sedation and then use special paddles to electrically convert his heart rhythm back to normal.
“You’re not doing that to me,” he declared.
I telephoned his mother and asked her to come to the ER right away. When she arrived I reviewed the situation with her and explained why it would be better for us to cardiovert her son now, before things got any worse.
“What does Johnny say?” she asked.
He doesn’t want to do it, but he’s too young and scared to make a rational decision.”
“If he doesn’t want it, he doesn’t have to have it.”
The best alternative to electrical cardioversion was a medication named procainamide, so I started him on an intravenous infusion of it.