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”.

A brief synopsis of my Thursday evening shift from hell: my first patient is a “regular” brought in by medics for being “too drunk”. He is chronically homeless and frequents the Shop Rite downtown, where he can be found panhandling and wheel-chairing under the influence. He wears a lanyard that says “I heart Jesus” but I’m skeptical. His beard looks like as though it is full of hepatitis and broken dreams. He’s currently laying on a hallway stretcher yelling that he needs to pee. I hand him a plastic urinal, which he promptly throws at me, then proceeds to roll over and pees on the wall. I’ve clearly set the bar too high. My other hallway patient turns out to be significantly more pleasant. He’s too intoxicated to provide a name and has no legal identification. He waddles drunkenly up and down the hall and keeps yelling “I didn’t kill nobody” in a thick Mexican accent while spitting bits of half-chewed deli meat in our faces. A turkey sandwich is the extent of the medical treatment he will receive throughout his 39-minute admission, during which time he will threaten to impregnate roughly 60% of our staff members with his “Mexican jumping beans”. While watching him pace the hospital hallway, my attention is suddenly diverted from “Mexican Danny DeVito” by the sound of medics dropping a patient off in my empty room. Upon inquiry, I learn that his chief complaint is “stung by 14 bees”. Turns out he threw a can of Coke at a hornet’s nest. I bury my face in my hands and think, “Darwinism is dead”. Meanwhile, a new resident walks out of my 16-year old patient’s room where he is about to perform an I&D (irrigation and debridement) of a dental abscess on a minor and asks, “do you think I need a consent for this?” I look at him and say, “you’re the fucking DOCTOR!” He looks bewildered and uncomfortable so I casually insinuate that I wouldn’t even high-five someone under the age of 18 in an emergency department without a consent for fear of immediate helicopter parent-driven litigation. Then I give an exaggerated wink to indicate that we’re on the same page here. He continues to stare at me blankly until I log into the computer, print him a consent form, and coach him on the 3 minutes of social and conversational skills that will be necessary for him to obtain consent. I’m telling you, take a scalpel out of a surgeon’s hands and you might as well be talking to a monkey with expensive malpractice insurance. My next patient is a gentleman who was brought in by medics because the police found him “passed out” (or perhaps just stargazing!) in his backyard next to an empty bottle of vodka. I draw his blood, place an IV in his arm, and hang a liter of fluids to flush out some of the inevitable hangover-related regret. I’m on my way to to meet my next patient when I hear a crash. He has somehow managed to rip his perfectly-placed 18-gauge IV out of his vein and is now bobbing and weaving down the hallway, leaving a trail of blood spatters in a zig-zag pattern like a drunken Sherlock Holmes. His “trail of tears” leads to the bathroom, which now looks like the last 5 minutes of a Quentin Tarantino movie. I flag the housekeeping staff down to come mop up the massacre and I hear him mutter something in his native language that I can only assume is “white devil”. I check the computer for my patient’s test results and ascertain that his blood alcohol level is 412 (for reference, the legal limit is a BAC of 0.08 or a blood alcohol level of 80. This man has a BAC of 0.412 and a blood alcohol level of 412. Most researchers agree that 450 is fatal). My last patient of the night is an obese, elderly black lady named Felicia who has come to the emergency department for “severe” abdominal pain. The attending physician approaches her and says he recognizes her from last week. She responds “Imma be straight with you doc, last time I was here I was so fucked up on PCP that I couldn’t tell my elbow from my asshole”. Charming. By the time all is said and done, she has essentially received a billion-dollar workup complete with labs, medications, fluids, CT scans, an ultrasound, and everything but the kitchen sink. Turns out all of it has come back normal and the only thing she needed was a “life-saving turkey sandwich”. Her discharge paperwork is delivered just as my shift is nearing its end. I remove her IV, tell her to follow up with her primary care doctor and half-sprint out the door like an inmate who has just finished serving a 10-year prison sentence. Bye, Felicia…