The main qualifications for working in the Emergency Department in our current day and age include splitting your time and attention between people who are unfathomably intoxicated and people who are convinced they have Coronavirus. Sprinkle in a handful of heroin OD’s and the occasional victim of gang violence and it all comes together to produce quite a stressful Wednesday afternoon. On one such hump day, I found myself leaving the time clock and coming face to face with an interesting patient load, the first of whom was a chronic alcoholic who looked roughly thirty years older than his alleged age of 48. He reeked of stale cigars and Keystone Light and his long, unkempt beard looked like it was full of regrets. He had checked in for “witnessed seizure” but was refusing to corroborate the full story. Upon further questioning, he admitted that the seizure had been “witnessed” by his dog. Excellent. On to my next patient, an obese, middle-aged black lady whose family had called 911 for “altered mental status” when they were unable to arouse her for dinner. The medics dropped her off in my empty room as EMS handed us roughly six different bottles of prescription medications… evidently the patient had a history of chasing her Percocet with Moscato every afternoon during Family Feud. As we rolled her on her side, I noticed the resident pull an object out from underneath her. Evidently her remote control had been wedged between her ass cheeks. He handed it to me and casually said “we should give this back to her when she leaves. I hate it when I lose my remote control”. I rolled my eyes and placed it with the rest of her belongings but was quickly interrupted by a 65-year old “CPR in progress” being rolled into my last open room by paramedics. Numerous medical staff assembled at the bedside, preparing all of the essentials for a “code blue”. The two procedural intubation medications were drawn up, Etomidate for sedation and Succinylcholine for paralysis. A young nurse who was newly off orientation had each medication in hand and was standing off to the side, looking puzzled. She finally called out the mnemonic phrase utilized for remembering the order in which to give the intubation meds. An entire room full of medical staff looked on in horror as she yelled “DATE BEFORE YOU SUCK” (Etomidate before Sux). The attending physician cringed as Lisa the Loudmouth pushed the medications and the patient’s airway was taken. After eight rounds of CPR and various attempts at interventions, the ED doc made the decision to call the code. We all stood for a moment of silence (even the novice nurse with the underdeveloped social skills) and then prepared the body for the morgue. As my partner and I removed the patient’s clothing in preparation for the body bag, we noticed something cold in between his legs. Upon removing his layers, we discovered that his family had shoved an entire frozen Cornish game hen in his pants in a misguided attempt at “cooling him off” after he had “fallen out”. Evidently he had a well-established history of heroin use and would frequently overdose, which resulted in many a cold shower by proxy and apparently the occasional foray into frozen poultry. I made a mental note to tell our community nursing program to educate our drug-abusing patients about the majesty of Narcan in lieu of holiday dinner entrees as I was interrupted by my intoxicated hallbed patient handing me a microwaveable deep dish pizza that he had evidently brought with him. As he asked me to heat it up for him, I realized I probably should have known from the moment he walked in with three full suitcases that the hospital was his home now. Onto my final patient, a man in his early thirties who had checked in for groin pain after having sex earlier in the day. I walked in just as the surgical resident was explaining that his imaging showed a “penile fracture” and he would need to go urgently to the Operating Room. His girlfriend started bawling dramatically as if she had just realized he unsuccessfully dodged the 1940 draft into World War II. I rolled my eyes and thought to myself that if I were this chick, I would be running up and down the halls, high-fiving strangers and bragging about my dick-shattering sexual prowess. As I wheeled my patient up to the OR and attempted to make small talk (turns out the weather forecast isn’t all that interesting when your manhood is literally shattered) I decided to keep it light and wisely remarked “congratulations on a Hump Day to remember”. The anesthesiologist glared at me as I made my way back downstairs to the ED, reiterating our unit’s reputation as a bunch of slovenly medical rule-breakers, and proud of the fact that despite my best efforts I still hadn’t made the most inappropriate comment of the day. That gold medal went to Lisa for her reminder to all of us to always date before you suck.

Friday afternoon in the Emergency Department is typically the calm before the human-induced storm of rampant substance abuse, public urination, and overall questionable decision making. This Friday evening shift was no exception. I arrive around 3pm and I’m immediately met with a litany of human despair. My first patient is a woman who has checked in with the chief complaint of “my cookie is crumbling”. Evidently she had been experiencing vaginal discomfort and a malodorous “cookie”. It will later be determined that she has tested positive for chlamydia, a revelation which will appear to shock her to her core despite her admission that she “only uses condoms when I know for sure they got the clap”. My second patient turns out to be 4 juvenile delinquents who decided to steal a car and go joyriding through the city, only to bust out a sharp turn going 50mph and subsequently rear-end a parked car containing two undercover cops. The oldest one is 17 and appears to have made an underwhelming attempt at growing a mustache. He is scowling at the 15-year old who is currently trying to exonerate himself by sobbing at a city PD officer and begging everyone not to tell his parents. The two backseat passengers, a 16-year old girl and her 14-year old sister, both look completely unfazed, almost to the point of boredom. The younger one stops filing her nails long enough to ask me if I can go get her a cheeseburger. I’m unable to summon the energy to even roll my eyes at the ridiculousness of the comment and I walk out of the room just in time to see the cop chasing the still-handcuffed 15-year old boy down the street. Hopefully his long-term game plan includes handcuff keys. My thought is interrupted by my third patient, who has been placed on a hallway stretcher for increased supervision. She’s a large, black woman in her early twenties who is extremely high on PCP. She’s wearing a “Champion” headband upside down and is actively strangling a pair of yoga pants. Her camel toe has a camel toe. As I walk outside to call for backup security for my small gang of juvies, she decides that right now is the moment she is going to execute a flawless HANDSTAND in the middle of the hallway. I roll my eyes and silently judge her gymnastics move as a solid “8.5”, rounded up for excellent showmanship (she stuck the landing). I corral her back into her stretcher as she threatens to do a split. I beg her to lay quietly and bribe her with a turkey sandwich and the promise of discharge paperwork if she can go another 30 minutes without any acrobatics. I move on to my next patient, a gentleman in his late 40’s who has self-presented to our every-classy Emergency Department with the chief complaint of “wedding ring stuck on penis”. Per the patient, during a verbal altercation, his wife had exclaimed “if you love your penis so much, then why don’t you just marry it?” Ever the literalist, this man shoved his dong through a small piece of jewelry representative of the everlasting bond between man and wife. After several wildly unsuccessful attempts at undoing his efforts, he was forced to come to the hospital where a pair of ring cutters, traditionally used to excise wedding rings from fingers that have swelled from trauma, was utilized to cut the ring in half, freeing his swollen member from the strangling of his wedding ring and also likely from his marriage itself. He is served his discharge paperwork with the phone number for a popular local marriage counselor, as well as education on how to properly fit and utilize a cock ring, and he walks out of the front door to the faint murmur of laughter and nurses commenting “he should have gone to Jared”. Exhausted from all of the shenanigans, I enter my last patient’s room hoping to achieve my first encounter of the day with a normal human being. My dreams are immediately dashed as I walk in to find a very intoxicated gentleman who is theatrically attempting to smoke a thermometer probe. My look of disbelief appears to have done nothing to deter him from this behavior and he looks at me and winks. Shortly thereafter, I notice the collection of blood pressure cuffs he has somehow accumulated. Another nurse informs me that he has been wandering into various patient rooms, stealing the blood pressure cuffs, and hoarding them on his stretcher. I decide to have him searched by the constables in case his kleptomania extends farther than a fixation with obtaining vital signs. Five minutes later, an overweight, curmudgeonly lady-constable waves her wand over his body and searches his belongings while he rambles incessantly about half-priced apps at Applebee’s. As she walks out of the room and says “all clear” into her walkie-talkie, I hear him yell “happy Valentine’s Day in case no one has ever told you that”. It’s mid-January. I shake my head in utter defeat and as I prepare to clock out from yet another Friday night shift, I silently thank whatever higher power exists for the currently un-crumbled state of my cookie.

It’s only 8am and I’ve already been urinated on and proposed to; by the same man. Flu season in the Emergency Department is the ninth circle of Hell and every provider is another discontented Judas Iscariot, frozen in a vast and limitless landscape suffering penance for our betrayals, which evidently include a degree in the healthcare field. My 12-hour day begins with a curmudgeonly 70-year old ex-Navy Captain who was also a professional clown for 35 years. He is aggressively non-compliant with all medical recommendations and has come to the Emergency Department in SVT (supraventricular tachycardia) a potentially life-threatening heart arrhythmia. Upon further testing, we discover his urine drug analysis is positive for cocaine. He is currently watching Duck Dynasty and yelling about his ex-wife being a “common prostitute”. He explains (unprompted) that she was “tooth-less, tit-less, and leg-less” from the “sugar attacks” aka: diabetes. Evidently non-compliance was the foundation of their short-lived matrimony, which was filled with celebratory cocaine benders chased with PBR and candy bars. I move on to my next patient, a woman in her late 40’s with what can only be described as “crazy eyes”. She was brought in by EMS after she was found dancing on the sidewalk and scaring small children. Her blood sugar upon arrival was north of 650, (normal is around 100). I call the facility in which she lives to try and gather more information and I’m informed that they apparently have no idea she has even left. The woman on the phone begins yelling “you need to get her a 1:1 safety sitter immediately or she will literally eat everything”. I turn to look at the patient, who is holding what used to be a jar of about 75 paper clips, but which is now looking suspiciously low. I promptly call the Charge Nurse and ask her for a safety sitter, confessing that I accidentally let my patient eat somewhere between 15 and 30 paper clips while I was on the phone with her facility. I roll my eyes and make a mental note to let the doctor know that an x-ray is probably in her future. I move on to meet my next patient, a skinny 22-year old kid with green, spiky hair and a two-way nose ring. He had been treated for an STD and is ready to leave. I hand him his discharge paperwork and his prescription for antibiotics, and he flamboyantly skips down the hallway to freedom. No less than 20 minutes later, I receive a phone call from the triage nurse. She explains that my patient has been brought back in by the police. Evidently in the last 20 or so minutes he walked out to the waiting room, found a young woman who was also discharged, traded her his pills (which were an antibiotic) for her bus pass under the guise that she was scoring prescription Xanax, walked across the street to the YMCA where he was refused a bed that night, left disgruntled and walked out of their door, pulled down his pants and pooped on their front steps. The triage nurse is calling to let me know that she’s putting him back in the same room again and I begin to develop a headache from rolling my eyes so many times today. I pop back in to check on my paperclip consumer, only to find her break-dancing down the hallway. Upon further questioning, she explains to me that this is the best way to lower her blood sugar; science clearly has not caught up to her yet. I make a mental note to reprimand the safety sitter if she ever comes back from her lunch break. On to my next patient, a sweet 100-year old lady with an adorable Southern accent, who is laying on a stretcher in the hallway. I walk up to introduce myself and she promptly coughs out HER TEETH into MY HAND. I back slowly away as any hopes I had for having one normal patient interaction are immediately dashed. I walk into room 4 to meet my final patient, a 45-year old guy who has “end-stage man-flu”. He is lying in bed, moaning and acting as though he may never shotgun a Bud Light again. His tragic diagnosis is an aggravated case of the sniffles. Three young kids crowd around his bedside as he imparts death-bed level wisdom such as, “never end your night with a Four Loko” and “please bury me in my favorite sleeveless lacrosse jersey”. I roll my eyes for the zillionth time and walk away, just as he’s explaining to a 6-year old “never trust a woman who says she’s on the pill”. I stop back in for one last check on my hungry hippo and find her sitting quietly in her room, drinking watermelon juice. I have no idea where she found watermelon juice, there is literally no watermelon juice in this hospital. With my spirit already broken, I shrug and walk back into my 100-year old patient’s room. The doctor is requesting a urine sample to check for a UTI and she needs to be catheterized but there are no rooms, thanks to our current seasonal influenza epidemic. Shirking my last single thread of guilt, I reluctantly recruit another nurse to help me wheel her into the viewing room, which is an area reserved for patients who have died where their family members can quietly view their bodies before they are brought to the morgue. We wheel her stretcher into the room and she exclaims “it smells funny in here”. We catheterize her and get the hell out of there. As I walk past my man-fluenza patient, I hear his last piece of wisdom “take care of your mother Tommy, you’re the man of the house now” and roll my eyes for the final time before clocking out and coming to terms with the fact that I catheterized a 100-year old woman in a viewing room. Fucking flu season.

I had barely clocked in for my last shift of 2019 when I hear the call overhead, “Trauma Alert, room 4, patient is here”. I grab my stuff and head over to my assignment where I’m greeted by my first patient of the day, a 19-year old who is sitting straight up in a wheelchair, drinking McDonald’s sweet tea while medical personnel flood his room and start prodding him. I recognize him from the last time he was here, when he had been shot in the leg and had to be transferred to the operating room for emergent surgery. Evidently he had been shot again, this time in the shoulder. Upon further questioning, he reveals that he stopped at the McDonald’s drive-thru on his way to the hospital because we “never let anyone eat when they come here”. I stare blankly at the patient, imagining the look on the drive-thru worker’s face when they saw him bleeding profusely in his car, and turn to the surgical resident who rolls his eyes and says “the anesthesiologist is going to love the fact that his surgical patient just took down a quarter pounder and large fries”. The patient shrugs and tosses his sweet tea into the nearby trash can, burps loudly, and declares that he is tired and will now be taking a nap. Based on the amount of blood loss (and carbo-loading), his acute fatigue is justified and we rush him up to the operating room to attempt to salvage his driving arm for future McDonald’s runs. Onto my next patient, a fantastically intoxicated gentleman in his late 50’s who is making loud (albeit accurate) duck noises in his stretcher which he periodically interrupts to proclaim “I’m quacking off!” I introduce myself to him and he immediately responds by yelling “your socks are untied!” I promptly exit the room to let him sleep it off (or quack it off). My next patient is a woman in her late 40’s with what can only be described as “crazy eyes”. Her chief complaint is “a snake is following me. The doctor sent me in for a “T scan”. Upon further questioning, she reveals that she was at Nordstrom’s when a snake fell from the sky and bit her on the head so she moved to another store and wouldn’t you know it, the same snake tried to bite her again so she called her doctor who said she should come to the Emergency Department. She admits that she is unsure what a “T scan” is but she insists that it will allow her to throw the snake off the trail. I halfheartedly nod my head in agreement while stealthily calling the psychiatric crisis team to come pick her up. My next patient is a young woman in her early 20’s who had evidently written a Millennial-style, overly-dramatic “so long cruel world” Facebook post, popped a handful of Klonopin, and then proceeded to eat fried chicken until the medics arrived and dumped her unceremoniously into room 3, where she explained to me that she had found the chicken in the backseat of a van. I told her I needed to get rid of it and she replied, “but it’s my last meal”. I rolled my eyes, explicitly aware that she would make a full recovery and probably start some sort of “hashtag Klonopin and chicken” movement on Instagram, gain 10,000 followers, and become a social media “influencer” by next week. I left the room to go meet my fifth and final patient, a gentleman in his late 60’s who had checked in for “wounds from diabetes” which turned out to be a bit of an understatement. The man had fallen asleep multiple times over the past few months while holding lit cigarettes and had evidently burned off about two to three quarters of each finger on his right hand. When my shift began, he was already admitted to the floor for observation and IV antibiotics. I walked into his room and introduced myself but he was in a panic. Evidently he was requesting to sign out against medical advice because he wanted to go home and charge his jazzy scooter. With no fight left in me, I relented and went to find the AMA paperwork and some educational pamphlets on smoking cessation before he burned his entire neighborhood down. I handed him the information and he hobbled out the front door. I wished him good luck, and as he waved back at me with roughly 3.7 fingers, I thought “2020 can’t possibly be any weirder than this”.

‘Twas the night before Christmas, when all through the ED,

Triage was overwhelmed, it was standing room only.

The patients were hungover, slumped in a waiting room chair,

In hopes that IV fluids and Ativan soon would be there.

The patients were nestled all snug in hospital beds,

While visions of discharge orders danced in their heads.

The charge nurse with her clipboard and I in my cap,

Rolled our eyes when the resident declared “I’m taking a nap”.

When out in the parking lot, there arose such a clatter,

I sprang from my chair to see what was the matter.

Away from the triage window I flew like a flash,

And out in the parking lot, I heard a loud crash.

The moon glowing bright amidst the ongoing construction,

Gave the illusion of light, and the smell of combustion.

When, what to my wondering eyes should appear,

But an ambulance passenger yelling, “I only had 2 beers!”

An intoxicated gentleman, it soon became quite apparent,

I knew in a moment the patient was “Clarence”.

More rapid than eagles, his curses they came,

And he sang “Boyz II Men”, the songs always the same.

As drunk as a skunk, he smelled like stale pee,

We instructed the medics “take him to hallbed 3”.

He smiled a toothless grin and to our great dismay,

Was still wearing the last t-shirt we gave him, it said “Trauma 5k”.

He made his announcement, “Clarence in the House”,

Then promptly urinated, the floor completely doused.

He smiled so widely, a jolly and toothless grin,

Then requested a turkey sandwich with a chaser of gin.

He was dressed all in Goodwill, from his head to his foot,

And his clothes were all tarnished with cigarette ashes and soot.

A bundle of heroin he had flung on his back,

And his poor dental retention insinuated he liked to use crack.

His eyes- oh how bloodshot! His dimples, how merry!

He winked at a new nurse and threatened to “pop that cherry”.

A harsh reprimanding put Clarence back in his place,

And his bed alarm was turned on, as he pouted his face.

The tip of a vape pen he held tight in his teeth,

And the smoke it encircled his head like a wreath.

He was skinny and pungent, a right jolly old elf,

And I let him walk to the bathroom, in spite of myself.

He spoke many words, then went straight to his work,

He shook it three times so I said “stop now, that’s just a jerk”.

In utter dismay, I walked him back to his stretcher,

He invited me to lay down and I declined (the drunken, old lecher!)

He jumped onto his bed, and was soon fast asleep,

We resumed our patient care, as he made not a peep.

But I heard him exclaim, before he finally passed out,

“Jiggly Baby, Clarence in the House!”

A brief synopsis of my Friday evening shift in the Emergency Department: I walk in to greet my first patient, a 62-year old lady who has summoned me into the room by unceremoniously screaming “NURSE, I gotta poop!” I sprint into the room to find her squatting above a knocked-over trash can and yell at her to wait 2 minutes so I can grab a bedside commode. I deliver the portable porcelain throne just in time; crisis momentarily averted. Roughly 10 minutes later, she calls me back into the room to demand her home-dose of pain medication. Clearly she has come to the hospital to poop and take a nap (it occurs to me that we are running the world’s most expensive adult day care). I calmly explain to her that we are currently in the midst of a national shortage of IV Hydromorphone, Morphine, Lorazepam, and IV fluids (at this point we’re essentially a hospital stocked with band-aids, turkey sandwiches, and regret). I explain to her that she will need to take oral pain medication for now and I bring her a cup of ice water. She rings her call button 5 minutes later to tell me she needs IV pain medicine immediately because she can’t stop vomiting and points to the floor where she has dumped half of her ice water next to the stretcher, which I am apparently supposed to be mistaking for vomit. She promptly turns and spits into the ice cubes for dramatic effect. I shake my head and walk into my next patient’s room. She is a confused, elderly black lady who was re-routed from a nursing home’s dementia unit to a psychiatric facility because she was becoming increasingly agitated. The ambulance driver refused to transport her because she was “not competent” enough to sign transportation consent because… plot twist: she has dementia. She is currently yelling into the abyss for someone to let her “out of the basement”. The doctor has ordered an intramuscular medication to calm her down. I draw up the medicine and inject it into her upper arm. She immediately tries to slap the needle out of my hand and yells, “don’t you give me another negro shot”. I back slowly out of the room, 80% convinced I’ve just committed a hate crime. I’m immediately distracted by medics dropping off a patient into my empty room. It’s a 22-year old who is 38 weeks pregnant and having contractions. She is screaming that her water broke and demanding an epidural as nurses and docs start rushing to the bedside. Evidently she has had zero prenatal care and the baby daddy (much like the 2019 New York Giants) is never showing up. The resident is telling her to push and saying terrifying things like “I can almost see the head”. Another nurse is timing the contractions, which are getting closer together. All I keep thinking in my panicked state is “I should have paid more attention during Labor and Delivery class”, and “what the fuck is a mucus plug?!” I leave the chaos of the room as I’m met with the triage nurse wheeling in a stretcher with what appears to be a large African American lady in her late twenties wearing purple spandex pants that can only be described as “not enough fabric”. Her camel toe has a camel toe. She is already tethered to the stretcher by velcro wrist and ankle restraints and is accompanied by 2 County cops and a handful of constables. She is screaming threats and rocking the stretcher back and forth. The ED physician wastes no time in giving a verbal order for an intramuscular injection of ketamine, a powerful sedative often utilized for surgical procedures. We draw up the med and prepare to inject her while 7 constables hold her various flailing extremities. She screams at the nurse next to me in protest and calls her a “white cracker”, which really just feels redundant. We administer the meds as she begins to direct her verbal assaults towards the ED physician; a jovial, balding doc in his late 50’s with thick-framed glasses and a good sense of humor. She screams at him that he shouldn’t be at work while his wife is at home taking a “big black cock”. He shrugs his shoulders and casually comments, “that’s probably not what she’s doing”. Eventually the drugs kick in and she suddenly looks at all of us, bursts out in a huge smile and says, “y’all done transformed. I’m glad we’re hanging out like this”. Another nurse high-fives me and yells, “ketamine FOR THE WIN” as the patient passes out in a whirlwind of purple spandex and shame glaze. I walk back to the computer to do some charting as another patient is led into my last empty room by the triage nurse. He’s moderately intoxicated and is holding on tightly to his right shoulder. He claims to have dislocated it while taking out the trash and asks repeatedly for a note signed by the doctor stating that he no longer has to take out the trash at home. We throw an IV in his arm and prepare to do “procedural sedation” to pop the shoulder back into place at the bedside. We hook him up to the monitor and I administer a dose of propofol, a short-acting sedative that will erase his memory of the quick procedure. In 10 seconds, his shoulder is back in its socket and his arm is placed in a sling. As he begins to wake up from the medication, he notices a box of cotton balls next to the glucometer machine and says “my friend eats those. She eats cotton balls and she eats baby powder with a spoon”. Before I can ask for clarification, he adds “and my other friend digs through the trash so she can smell dirty diapers”. I tell him his friends are weird and I wheel him over to x-ray to get imaging to confirm correct placement of his shoulder. As I walk back to my assignment and get ready to give report to the oncoming shift, I’m oddly comforted by the realization that I will always have a job as long people continue to do insane and borderline criminally stupid things to themselves and others and that is truly the Christmas gift that keeps on giving.

This morning I walked into work and was immediately confronted by one of my greatest fears: the psychiatric area of the Emergency Department was “at capacity” and the patient overflow would be dispersed throughout the remainder of the ED. As a result of some cruel irony by the Universe (considering my boyfriend is a psych nurse) those patients were mostly all “dispersed” to my assignment. I therefore spent a harrowing 12-hour workday amongst a constellation of human despair. My day as follows: my first patient is brought in by medics because she is “suicidal”. She starts by chatting incessantly about her (equally crazy) roommate’s antics while I attempt to obtain an accurate medical history. She interrupts me multiple times, once to stare at me directly in the eyes and sing an original song entitled, “I’ll never, ever, ever, ever forget you”. At one point she even floats the idea of friendship bracelets. I leave her with her imaginary friends to go meet my next patient, a gentleman who was brought in by County PD after he had been found completely naked and running through the city streets. Upon arrival, he insists that he’s wearing clothes (although the image of his naked taint burned into my retinas says otherwise) and at one point he even attempts to use his exposed genitals as a negotiation tactic for a turkey sandwich. His shenanigans eventually earn him a 24-hour commitment to an inpatient psychiatric facility and a 1:1 safety sitter who looks to be about 20 years old and whom he will solicit upwards of 15 times for a blowjob during her 8-hour shift. As I’m mixing an IM medication to calm him down, I’m interrupted by the first of what will be many call bells from my first patient and evidently my new BFF. She has rung her bell to ask if I like dogs. Throughout the course of my shift, she will hit her call button somewhere between 12 and 16 times exclusively to tell me that she is brushing her teeth, proving that though she may be socially subpar and possibly also suffer from a spectrum disorder, she has phenomenal oral hygiene. I walk out of her room as I’m met with a new patient, a man whose face is covered in blood after “those little bastards at the roller rink pelted rocks at me with a slingshot”. He’s rambling about how he used to do blow off the deck of his private boat when I hear New BFF’s call bell ring again. She asks if we have any pears. I walk out of her room, literally at a loss for words and come back to see my patient’s blood-covered mouth belting out an intoxicated albeit touching rendition of Phil Collins’ “In the Air Tonight” (complete with overzealously pantomimed air-drum solo). I escape to my fourth and final patient’s room. He’s an ED “regular” named George who comes in routinely when some well-intentioned but misguided “Good Samaritan” sees him on the side of the road, passed out in a haze of mouthwash and regret, and calls 911. George drinks bottles of Listerine (which he steals exclusively from CVS and is always the same flavor- the nasty, flavorless yellow one, which he claims has the highest alcohol content) until he gets just drunk enough to lose control of his bodily functions somewhere around 4th Street, at which time the local paramedics will dutifully heave his half-limp body into their ambulance and dump him off in our triage area. So they bring him in and he’s almost completely unresponsive, even as we sternal rub him as hard as we possibly can. The medics have inserted a nasal trumpet (an artificial airway that is initiated on unresponsive patients to essentially guarantee a patent airway en route to the hospital) so I shove an ammonia packet up George’s nasal trumpet to no avail. He mouth-breathes the stench of the worst flavor of Listerine into my eyes as I try to find a vein on his arm to obtain IV access so that I can medicate him with Narcan in the hopes that today he chased his Listerine with some heroin and we can easily reverse his lethargy without having to intubate him. As I look for a vein, I’m distracted by the literally thousands of bed bugs crawling all over his body. A disgruntled ED doc comes to his bedside and in an effort to elicit a response to painful stimuli, he takes a needle and gently pokes George’s left foot and then right foot, neither one generating any kind of reaction. At this point I chime in “to be fair, George has loss of sensation to one of his legs from a prior CVA and also neuropathy to his bilateral legs from decades of diabetic noncompliance”. The doctor rolls his eyes and mumbles something about, “possibly making this job even harder”. Another nurse adds, “also this might not be medically relevant but he pooped in the Employee parking garage last week”. Exasperated, the doc walks out of the room and we get to work setting George up comfortably so that he can sleep off another Listerine binge and question why we ever chose this career in the first place. As I leave his bedside, my new BFF rings once more to ask if we can braid each other’s hair. I silently curse my boyfriend and his co-workers under my breath as I back slowly out of the room, slightly fearful for my life. I finally make it through my shift and arrive home to find the only true remedy for such a mentally and emotionally exhausting day… a plate of bacon. I drown my sorrows in greasy meat as my dog empathy-eats a few slices. We head upstairs to bed where I wake my boyfriend to whisper a thank-you for the bacon and to provide a gentle reminder that if I walk into work again tomorrow and I’m forced to have one more conversation with my new manic BFF or see any more of Creepy Naked Guy’s creepy naked taint, then I will walk my ass across the ED to the locked psychiatric unit and sign myself in as a patient.

1. When the seemingly never-ending shortage of 1-mg vials of Dilaudid is finally over
2. When you bear witness to the undeniable healing power of a sacred, life-saving turkey sandwich
3. When the Physician’s Assistant in Fast-Track insists that the rash is NOT contagious despite his recommendation for the administration of antibiotics for a full 10-day cycle
4. When you serendipitously discover a gait belt just in time for your intoxicated hallway patient to jump out of her stretcher without her hospital-approved, non-skid socks and with the coordination of a drunken toddler
5. When you think a patient has bed bugs but it turns out that he just ate a bunch of chocolate sprinkles in a drug-induced case of the munchies
6. When the Tylenol is ordered rectally but the patient insists he has an allergy to any medication that is non-narcotic
7. When a very opportune pair of hemostats is clamped down on a tube just in time to prevent a bodily fluid from coming in contact with your open mouth
8. When you figure out that your acutely agitated, 99-year old patient’s violent tendencies are pacified only by watching wrestling and you fortuitously discover a TV channel devoted solely to reruns of “WWE Raw”
9. When you realize your patient’s medical knowledge is a tornado of misinformation and you’re able to have a veritable “teaching moment” by drawing anatomically correct pictures in crayon on a paper towel
10. When you’re frantically trying to remember a single shred of information from your “labor and delivery” class and the transport team comes to pick up your excruciatingly pregnant patient and take her to another hospital before your calm patient turns into 2 screaming patients

Happy Thanksgiving to all medical staff and first responders!

In case you ever hate your job… tonight I spent an hour and a half tasked with the momentous obstacle of “decontaminating” a homeless woman from body-wide lice so that she could receive life-saving medical treatment. Evidently the med-surg floor in our hospital has an aversion to contagious critters bordering on a public health hazard. This particular woman arrived in the Emergency Department, complaining of dizziness and lethargy. Her hemoglobin was subsequently found to be 6 (normal for women is 12-15), necessitating a blood transfusion in order to allow her to have more circulating blood and thus, improved oxygenation. However, she was also living on the street and came in covered head to toe in body lice, which landed her in room 12 and myself as the lucky recipient. I received report from the triage nurse and immediately readied our million-dollar, Ebola-prepared “Decontamination Room” where I would be tasked with giving this homeless woman a de-lousing treatment. The specialty shampoo arrived from pharmacy and I walked her to the Decon Room like a death-row inmate (she mourning the death of her dreadlocks and I mourning the death of my innocence). I gave report to the other nurses in my area, warning them to keep an eye on the man in room 13 as he was overwhelmingly high on PCP and was currently strapped down to his stretcher in sturdy, Velcro, police-grade wrist and ankle restraints, and shouting obscenities to innocent bystanders, most of which centered around “dat booty”. I then donned my PPE (personal protective equipment), prayed it was up to standard, and set about to de-louse my lady. We shampooed for a full 15 minutes and as I combed thousands of live lice through her long, black hair and down the shower drain, I realized the imminent futility and broke the upsetting news that I would need to shave her entire head. Unfortunately, as this was my first true foray into hair styling, I had forgotten to bring the hospital’s one electric shaver with me. Realizing I would need to make do with what I had, I whipped out my trauma shears and went to town on this poor, anemic, lice-covered woman. I gave her a full buzz-cut with my scissors and then trimmed her lice-coated pubes (that’s right, lice inhabit ALL of your body hair), while the tiny insects crawled up and down my own gown, the sole protector between the bugs and my body. After a solid 45 minutes we were finished and she showered off and sat down in the wheelchair. I then walked back into my assignment, which my coworkers were allegedly “watching”, to find my previously restrained and immensely agitated PCP patient not only unrestrained but standing in his room completely naked, doing toe-touches and yelling “I need cardio!” while his enormous mother sat, overflowing a chair in front of him and yelled “boy, you best quit smoking that wet or I’ma whoop yo ASS”. As his behavior escalated from a level of ‘cheeky shenanigans’ to one of ‘vocally obnoxious and creepy Oedipal comments’, he was finally served his parting paperwork and was discharged to wreak havoc on the unsuspecting city. Meanwhile, Lice Lady was finally ready for a CT scan under the condition that she would be dressed in a full Haz-Mat suit. Ok, sure… cue world’s largest eye roll. I slapped a thin, blue gown on her, sprayed her with lemon-scented Febreze, cleaned 32 dead lice off the head of her stretcher with scotch tape, and wheeled her over. One minute later, the charge nurse comes over to tell me that she has a new patient for my now-empty room. Evidently this is a 29-year old female who was brought in by the city police when her landlord called 911. According to their report, the patient had been evicted 5 days prior but had thus far refused to leave her apartment and had subsequently torn up all of the drywall, dipped her hands in various cans of paint, and left a collage of brightly-colored hand prints all over the walls. She is brought in on a stretcher in handcuffs, screaming that there is a Nazi watching her house and calls one of the cops “Officer Hitler”. As she shouts 1940’s-themed verbal delusions of grandeur, various sedatives are drawn up and administered intramuscularly while she attempts to bite the constables restraining her. T-minus 20 minutes until sleepy time. Lice Lady is now back from CT scan and is finally ready to be admitted to the floor. I call to give report to the receiving nurse and finally put an end to this miserable shift. I walk out of the core and straight into the break room, where I give myself a prophylactic de-lousing treatment while I drink a shower beer and question the existence of a higher power. I drive home and as I lay down in bed, praying there is nothing crawling on my body or in my hair, I can’t help but think about whether I’m qualified for a career change to hair-stylist and also about how much tequila I need to drink to repress the memory of this hellish shift.

The following comprises the shift report I passed along to one unsuspecting coworker on this fine Sunday evening… your first patient is a 20-year old girl who suffered a minor heart attack this afternoon after doing a speedball (cocaine and heroin combo) last night and who is primarily concerned with snapping selfies and finding an emoji that properly represents her “near-death experience”. Throughout our journey to ultrasound earlier, she felt obligated to post about her incident on social media, complete with a request for “thoughts and prayers”. Her number of “likes” has been exceeded only by the amount of prayer-hand emojis that have graced her most recent GoFundMe, which is titled “Erikka Needs a New Heart”. Let the record show that she does not need a heart transplant whatsoever, but Erikka with the redundant “K” could likely benefit from a Narcotics Anonymous meeting. Your next patient is a large, black gentleman with dreadlocks who was brought in by ambulance 3 hours ago and is so fantastically intoxicated that he is still in the computer as “John Doe” because he has only opened his eyes once since his arrival. When asked if he was oriented to his immediate location, he answered “peanut”. At the current time, he is affectionately being referred to as “Shamu”. The only emergency contact listed on his file is someone who is hopefully going by an alias and is named “Dirty Martinez”. Upon reaching out to the alleged Mr. Martinez, the associated phone number was answered by a place called “Broadway Dry Cleaners”. Your third patient is a highly confused, elderly, albino black lady who could easily win first place in an Al Sharpton look-alike contest and who earlier rang her call bell and asked “where’s the party?” Roughly ten minutes later, she rang her call bell again and when asked what she needed, she turned somber and whispered, “how many people did I shoot?” I backed out of the room slowly with my hands visibly in the air. Clearly She-Sharpton had seen some shit in her day. Your next patient is a gentleman named Arnie, a regular who is frequently picked up on the side of the road by medics while publicly intoxicated, or when a good Samaritan spots him laying in a puddle of urine on a park bench surrounded by brown paper bags, used needles, and broken dreams. He sleeps off his bender on a hallway stretcher until he’s reached that sweet spot between “too drunk to even stumble” and “too sober to start asking for a turkey sandwich” and then gets booted back to his outdoor playground to strew drug paraphernalia around the neighborhood and serve as an incidental public service announcement for the hepatitis vaccine. Roughly 60% of the time, he is covered in bed bugs. Your final patient is another regular, a 20-something white girl who looks like she probably attends a support group for Millenials with peanut allergies and high-functioning anxiety which takes place inside of a Trader Joe’s every Taco Tuesday. She has a notorious list of previous visits, including “human bite to left arm” and “found running naked through train station”. Many more visits involve smoking PCP-laced marijuana and various assaults. Tonight she is here because she “smoked some bad weed and is having a panic attack”. She was medicated with a benzodiazepine for her anxiety and is currently sleeping on a hallway stretcher. She periodically wakes up, tosses her faux-dreadlocked hair theatrically, and makes random statements including “I need coconut water. Water is life” and “I am going to drive my car off this bridge. Please notify my baby daddy. Goodbye, cruel world”, before passing back out in a drug-induced stupor. When questioned regarding her past medical history, she adamantly proclaimed that her mother had died from prostate cancer. Upon further investigation, it was revealed that her mother is very much alive, does not have a prostate, and would like for us to please give her a call immediately when her daughter wakes up so she can come rescue her yet again from her poor decisions in true hyper-involved, Millenial helicopter-parent fashion. I wish I was making any of this up but unfortunately this was literally the cast of characters with whom I spent my Sunday evening, given new meaning to the term “Sunday Scaries”.