Bye, Felicia

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…