At either two minutes past 8 a.m. or two minutes past 8 p.m., my shift starts with "Excuse me, Ma'am, no Rollerblades in the hospital." It wouldn't happen if my brakes weren't so loud, but my back wheel is stuck so it screeches when I slow down. The ambulance bay, where I enter, is at the bottom of a hill, so I take that turn at about Mach 3 and screeeeech up to the trash can/ashtray/scumpit that sits just outside the door. I always imagine how funny it would be if there were an ambulance parked there with its back doors open and I crashed right into it and flipped up onto the gurney.
So, of course I smile at the security guard and say hi and his name, if I know it, then, holding onto the scumpit, I pull my skates off. If the security guard is nearby, he sometimes steps up and holds my arm to steady me. And sometimes … oh forget it. Clooney fantasies again.
I park my skates in their garage, which is a drawer underneath one of the computer stations, and make a beeline for the person I'm relieving. Invariably someone says, "You look so tan," and I say no that's sweat and then we start rounds. We stand in front of the board that, in very high-tech dry-erase marker, lists the patients, their doctors, and some of their relevant information, like if they're admitted or the next time they need blood drawn. People who aren't as anal about erasing as I am have, over the course of the day, left little pockmarks on the board, so as I hear about the patients I'm taking over, I flick the board clean with my finger.
My team consists of one or two other docs, and two or three nurses, three or four of whom are on break at any given time. We get busy, checking leftover labs or films and acquainting ourselves with leftover patients enough so that if some alarm goes off in their booths we'll know how they started out looking. Then we see the T.B.S.'s, To Be Seens.
Tonight, my first T.B.S. was a schizophrenic patient, escorted in by security, for "medical clearance" before transfer to the psychiatry E.R.
"Hi, I'm Art!!" he greets me, and I smile and say, "Well, I'm Jenny!" Art has a completely bald head and wire-rimmed glasses and a voice like a growl. He's like a cheerful Archie Bunker on amphetamines. He sits with one leg hanging over the side of the stretcher and rocks back and forth on his bed, talking continuously and calling every one of the security guards by name. When I ask him how he knows them, the whole group starts laughing. Art answers, "Oh, Dr. Jenny, you should see how I usually am. These guys have to strap my ass down. I get violent, huh guys? Isn't that right, don't I get violent? Oh, man, am I a handful."
He tells me he's been in detox 60 times.
"I drink and drug to keep the voices away," he explains, "and THEN," he went on, "I forget to take my medications, and then THAT makes the voices even louder."
I ask him what they sound like, and he pauses, searching for the right words.
"There are different ones," he says, talking more slowly than he had the whole evening. "The worst one, the worst one sounds like a deep frog. Like a demon."
"And what does it say?"
"It says, 'KILL YOURSELF, ART,' " Art hissed in a demon-like voice, sending chills down my spine.
"And you listen to it?" I ask.
Brightening again, "Oh, yeah, for sure."
"Even though you know it's not real?"
"Oh, hell yeah. I mean, shit, I hung myself back in 1991. I was pronounced dead—D-E-A-D. Then they coded me and got me back." He waved as a guard passed, "Hey there, what's up, Buddy."
I write an order for one-to-one observation, which is required for all suicidal patients. Then I stand, and patting him on the back, say, "We'll get you out of here soon so you can go to the psych E.R."
Once Art is taken care of, Suzanne, one of the nurses, sees me and slaloms through stretchers toward me. "Jen, you really shouldn't leave this lying around," she scolds, and handed me back my prescription pad. When I was an intern, a homeless patient stole my friend's prescription pad. He filled it out himself and turned it in to the pharmacist. On it was written: Mofeen, one pound.
"Jenny, what do I do after I suffocate it?" the medical student calls from one of the corner booths. I go in. A cockroach had crawled into a woman's ear while she was napping in her apartment and she came in to the E.R. because it hadn't left yet. Evidently, it thought there was a nice home to be had in that warm furry hallway, and ventured in. There, to its roachy dismay, it found no home, certainly no room for the rest of the family, and worst of all, no room to turn around to leave. Cockroaches evidently don't have "reverse." They also don't have very big brains, so they bang against, bang against, bang against the eardrum, each time forgetting about that whole eardrum thing.
The first step in the solution is to drip mineral oil into the ear canal to suffocate the bug. That takes care of that irritating battering-ram sensation. Once the creature is dead and still, you can irrigate it out with a water jet from a catheter. Frequently you have to resort of plucking it out with skinny skinny long tweezers. I plucked and plucked, but kept getting pieces of bug, no intact creature. By the number of legs I pulled out, I determined it must have been a billipede.
The cockroach was in that big roach motel in the sky and I was walking down the hall to the bathroom when I recognized a little boy going into the pediatric emergency room. I had taken care of him three days ago for the same asthma that be-wheezed him now.
"Day-SHON," I called, squatting down. This kid is so frigging cute. He turned and saw me, then spread his little arms and ran toward me. Happiest moment of my night. When I swooped him up saying, "I am SO happy to see you," he leaned forward and smashed his soaking-wet snotty little mouth right on mine, making a loud kissing noise. His mom stood by and laughed.
Finally, I walked outside to get a soda from the snack truck. Mohammed, God bless him, had ONE ginger beer left and he had hidden it in the depths of the ice pit for me.