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…

The following is the shift report I gave to the oncoming nurse who took over for me tonight in my esteemed and ever-classy place of employment… first patient: a kid in his twenties who came in because the pain medication his primary doctor prescribed him after surgery was “insufficient” by his standards. He tells me he is allergic to Tylenol and is therefore unable to take it for his post-operative pain lest he break out in a full-body rash and experience complete, unadulterated anaphylaxis. He is instead requesting a prescription for Percocet (which is a combination painkiller comprised of Oxycodone and yep you guessed it, Tylenol). According to the young pharmacology neophyte, Tylenol will literally kill him, yet Percocet apparently causes neither his skin nor his throat any adverse reactions… defying both science and logic. Second patient: a gentleman who came in after an episode of severe mid-sternal chest pain radiating to his jaw and left arm. Upon arrival, his coronary arteries are literally becoming more occluded by the minute while he experiences what we call a “heart attack”. I inform the physician of his EKG, which looks like the most ominous combination of squiggly lines. The plan is to transport him promptly to the cardiac catheterization lab, where he will undergo an invasive diagnostic procedure. While we await transport, I explain to him the risks of the procedure and read him a written consent full of fine print and legal minutiae. He responds by looking me dead in the eye and asking why the hospital no longer carries Coke cans since his last visit. I explain to him that we’ve discontinued Coca-Cola in a hospital-wide health initiative to combat “sugar attacks” (which for some reason is an inner-city term for diabetes exacerbations). I briefly contemplate rolling my eyes and hand him the consent. He sneezes on my pen, drops the consent on the ground, and asks if he can have a cheeseburger while he’s waiting to go to his “heart attack operation”. I walk out of the room, speechless. Third patient: an extravagantly intoxicated gentleman who was found and brought in by the city police after suffering a large laceration to his forehead. He obtained this wound by falling face-first in a parking lot while trying to eat an old container of Chinese food out of a dumpster. He is wearing two different shoes and admits to drinking “12 beers”. One of the cops, in an effort to be helpful, asks the man his name which elicits a response of “Fraggle Rock”. The officer walks out of the room, muttering something about “no pension is worth this nonsense”. Fourth patient: a large man who was wheeled into the room by county cops, already handcuffed to the stretcher, who had been fleeing the law and in a brief and shining moment of brilliance, had decided to eat the evidence (a crack rock) so as not to be implicated on drug possession charges. He ate a fucking crack rock. The cops arrest him anyway on the grounds that possession is still nine-tenths of the law, even in your intestines. He is arraigned at the bedside with a heart rate just a few beats shy of 200 per minute, pumping blood through a body that looks like it has never set foot on a treadmill. Fifth patient: a pleasantly confused gentleman who had been brought in by city police after he was found smoking PCP in a local park and arguing incessantly with a tree. He becomes singularly focused on leaving the Emergency Department around 5:45pm, appealing to anyone within earshot that he needs to leave promptly at 6pm in order to be on time for his “poetry meeting”. Within five minutes, our very pregnant and disgruntled ED doctor approaches him and states that if he can recite 3 original poems for her, then he can be discharged. He finally admits that he is many things, none of which comes close to a poet, and that he needs to make it home before his wife arrives so he can “start cooking so she won’t know I was in the park smoking wet”. Brilliant plan. For clarification purposes for those who function at a normal level in society, “wet” is essentially a marijuana cigarette dipped in PCP and/or embalming fluids, which escalates your level of intoxication from “I really want to dip a Crunchwrap Supreme in some peanut butter and chase it with a milkshake right now” to “there are tree-people watching my house while I sleep and I believe the only solution is to light the entire city on fire and then run naked through the streets while singing the National Anthem”. And that, my friends, is your brain on drugs.

I arrive at work this afternoon to learn I’ll be caring for Sheila, who has become a bit of a regular in recent times. She’s in her 70’s, has a sprinkle of dementia, a head bleed which can truly no longer be classified as “acute”, and a touch of alcoholism. I introduce myself to her (for about the third time this week) and go meet my other patients. I walk back to room 15 (I’ve been gone for roughly 120 seconds) to find Sheila eating chocolate pudding with a plastic knife because YOLO. Inevitably, the only way I’m able to wrestle the knife out of Sheila’s hand (as she continually threatens to stab me) is to promise her a Jack and Coke. So I hand her a cup of soda with ice and she says “thanks, cheers!”. She drinks all of it and then promptly passes out in her chair. She wakes up 20 minutes later and stands abruptly, announces that she is “lost in the sauce” and proceeds to urinate all over my shoes. She has now convinced herself that she’s drunk. She sits back down, looks at me and says “you make a stiff drink, bar-keep!” and then subsequently plops back down in her chair with the apparent intentions to “sleep this one off”. I proceed to spend the final 11.5 hours of my shift mediating a verbal brawl between a prostitute admitted for a head injury after being beaten up by her pimp and an elderly lady who had driven her car drunk and crashed into a stop sign because she was on her way to “warn the police about the impending spread of ‘V2k’ which is a ‘microwave weapon’ controlled by ‘target groups’ run by Hitler and Obama”. The hooker is tethered to a chair with wrist restraints (all of which makes her constant gyrating seem even more like a career-choice) and periodically calls out to various staff members to “untie me so I can go see ‘daddy’ and get some crack”. The elderly lady is wearing soft-mitt restraints, making her look like the world’s oldest bantamweight fighter, and soliciting any and all passerby to call the police because she is allegedly being held against her will. She eventually tires of harassing bystanders and shadow-boxing, but only after her wig falls off. Meanwhile, room 17 is ringing her call bell incessantly. I answer it, only to be informed that she needs a new sheet on her bed. She dislikes her current one because “it’s weird”. She’s pacified solely with chocolate ice cream and Trazodone. My last two patients are in rooms 13 and 16, one of whom is a middle-aged man completely oriented to his surroundings, yet whom insists on wearing a condom catheter and requests that I take his current one off and put a new one on so he can “see my technique”. The other is a 22-year old kid who crashed his car while driving drunk and upon being offered pain medications, launches into a tirade regarding the declining street value of the Percocet I’ve offered him in comparison with a plethora of other narcotics. He rambles on about opiate appraisal with the normalcy of two coworkers discussing mutual fund investments in a 401k. I stifle the urge to roll my eyes as I walk away; evidently Oxycodone is the Vanguard 500 of the inner-city crowd. I end my night by answering a final call bell, triggered again by the “weird sheet” lady. I walk in to see her sitting up in bed and holding what appears to be her tooth in her hand. She informs me, “it just fell out”. I look at her completely flabbergasted, throw my hands in the air and say in exasperation “I literally don’t even know who to call about this” and walk out of the room, past the newly-trained dental resident, past the pamphlet on “meth and dental retention” and out across the parking lot to the nearby bar to reconsider all of the life decisions which have led me here.

Synopsis of a recent evening shift: spending 8 hours finding new and creative ways to occupy the attention of a confused, elderly, head-injured African-American man named Warren who enjoys a nice cup of chocolate pudding with his Zyprexa and whom, despite his fractured hip, was on this particular evening insistent upon getting out of bed to escape his explosive incontinence. Consequently it was this very inability to control his bowels which led to the incident which will henceforth be known as “The Great Poop-nado of 2016” and involved irate nurses and techs who found ourselves begrudgingly scraping feces off of both bed side rails, an IV pole, and most disturbingly the closet door. I was unfortunate enough to partake in the aftermath of this devastating natural disaster and I was unsurprisingly tasked with cleaning Warren’s backside. Armed with enough toilet paper to stock a bathroom at a restaurant that exclusively serves Indian food, I steeled my reserve and attempted to render my gag reflex non-existent. It was with great apprehension that I embarked upon this vomit-inducing journey and began to put Warren through what I can only compare to some sort of human car wash. Roughly 4 seconds into wiping his ass, he began to call me a “common prostitute”, and warned me to “get your hands off me, you cotton ho”. I’m still not sure exactly what that means but it sounds both racist, as well as soft and absorbent. Midway through the bedside bathing, Warren decided to go rogue and began throwing punches. In a veritable “poop-splosion” the likes of which had never before been seen, Warren stopped suddenly and I was able to grab hold of his shoulders and steady him just in time for him to begin urinating all over my shoes. In my moment of shock, I almost missed his follow-up statement, “it’s time for a dookie”, followed subsequently by an impressive and quite possibly intentional absence of rectal-sphincter integrity culminating in a literal shit-heap on the floor. In what I can only assume was an attempt to completely outdo the level of disgustingness of any other patient to ever darken the doorway of our unit, Warren took a moment of silence before he began hocking massive loogies on the floor. At this point my tech and I did the only thing we could do, which was to laugh and sit Warren (still bare-ass naked and throwing punches) down in a chair while he continued to make threatening remarks, ever toeing the line of full-blown racism. Three packs of wipes and many washcloths later, the tech and I exited the room, still laughing about Warren’s creative and unabashedly racist comments and trying to figure out where we could get clean scrubs. With one remaining task on my mind, I got on the phone and called the doc so we could get Warren pended to a medical floor… so this is my apology to the nurses on Medical Overflow who have a nurse to patient ratio of 1:3, all private rooms, and adequate staffing. Sorry I’m not sorry for sending you the Crapped Crusader, enjoy the inappropriate comments and be sure to pack an extra pair of scrubs when you come to work tomorrow 🙂

How you know you work in an Emergency Department…

1) when a crack-pipe falls out of a traditionally clothed orifice during an initial patient assessment
2) when you ask for your patient’s medical history and her response is “nipple rings”
3) when you give a lady a tetanus shot and she thanks you because of her concern regarding the “rabid squirrels” that live outside of her house
4) when your patient walks unassisted to the bathroom and is found 10 minutes later “break-dancing in front of the vending machines”
5) when an acutely intoxicated patient throws a half-empty box of Franzia at you
6) when the room’s supply of hand sanitizer is becoming suspiciously low and your patient is becoming suspiciously sleepy
7) when a patient covered head-to-toe in prison tattoos cries real-life tears at the mention of a 22-gauge IV needle being inserted into his delicate ante-cubital vein
8) when you question why your confused, elderly patient is eating chocolate pudding with a knife and she looks at you and says “yolo”
9) when you walk in to see your intoxicated patient standing bare-ass naked in the middle of his room, doing toe-touches, and yelling “I need cardio!”
10) when you ask a head-injured patient what he is doing tonight and he responds “we’re going to order some lobsters and then we’re going to order some women”

Happy Emergency Nurses Week to all of my unbelievable co-workers and to all first responders!

On my first of many holidays in the ER, I spent 12 hours enduring the incessant ringing of call bells, 80% of which came from a 91-year old lady with a spinal fracture who was adamant about speaking to our unit’s management upon learning that she had been “deceived” because she had read my name on the whiteboard and assumed I would be Asian. Much to her dismay, I walked into her room, looking hospital-pale with my organs practically visible through my Irish skin and armed with an embarrassing lack of math skills, and she quickly determined that I was not in fact Asian. Meanwhile in the next room, a confused and head-injured woman who had gotten intoxicated and fallen down her stairs, rang her call bell. I answered it and asked what she needed to which she responded “I painted my horse”. Before I could stifle the impulse, I found myself asking why. “Umm duh”, she replied, “so it could be a unicorn”. Hard to argue. And just in time for her roommate to arrive on an old stretcher. Before I could say “welcome to the ER”, she was already demanding chemical relief. She gave the traditional med-seeking answer to her pain scale (hint: she was a 12 out of 10), and I went to grab her some meds and do her admission when I noticed her clutching her purse with a death grip (red flag). After a good deal of convincing, she handed it over. I raided the contents, and discovered that not only did this lady have a crap-ton of loose, unlabeled prescription meds, including Xanax and Klonopin, but she was stashing them in tiny glass jelly jars, which was both endearing and also indicative of a batshit-crazy cat-lady (my suspicions were later confirmed when she launched into a 20-minute tirade on her posse of pussies and their varying personalities). Onto the next patient room for another dose of crazy as I heard my 40-year old, heavily tattooed patient crying actual real-life tears because he was scared the IV nurse had to stick him with a needle. Relevant side note: this man had initially come to the ER because he had been shot in the chest. By a bullet. From a gun. Let that sink in for a moment. I held his gangsta hand while the IV nurse inserted a pediatric needle into his delicate gangsta ante-cubital vein. Meanwhile his roommate, an elderly gentleman who had deemed his hearing aids “optional” back in 1995, rang his call bell. I answered and asked if he wanted pain medicine. He responded “I don’t know about Thomas Edison”. I eventually gave up and walked back to my desk where I was met by the lady from patient relations, and as I calmly fielded all of her questions as to why I am not now, nor could I ever possibly become Asian, I had an epiphany that the ER is literally the scariest place to be on Halloween…