Ketamine FOR THE WIN

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.