Last night I was eating Thai food (again) with two nurses. A hysterical screaming that came from the triage area made us all stop and look at each other. Rachel started laughing and covered her mouth so she didn’t spit her food out. “Sounds like someone’s having sex,” she laughed. “It’s like that restaurant scene in When Harry Met Sally.”
There are different flavored screams in the E.R. There are the guttural moans that sound like they emanate from the person’s very soul. No one says anything—just order the morphine. There’s the hysteria-for-hysteria’s-sake screams. Just yell yell yell; you’ll be impossible to ignore. Then—the worst—the ones I call “the silent screamers”—the patients in so much pain they make no noise. Reminds me of when, as a child, I wondered why squirrels or possums didn’t make any noise when they got run over. Didn’t it hurt? Wouldn’t it have felt better to yell out, just once?
This woman was there to scream. She didn’t stop. Her boyfriend had to repeat her registration information several times for the triage nurse to hear. He screamed her name, “ROSE MILLER.” I put down my Pad Thai, looked pointedly at the nurses, said, “You’re welcome,” and walked over to the side of her gurney.
“Ma’am,” I said loudly, putting my hand on her sternum and patting in an effort to calm her down. I was tempted to cover her mouth with my hand but resisted. “I’m Jenny, one of the doctors here. What is wrong?”
“Oh, God. OH, OH, I fell in the bathroom,” she moaned.
Talking quickly lest the climax restart, I said, “What is it that hurts you?”
“Oh, God, right here,” she said, and with that she reached around and grabbed a handful of my rump.
I asked her if she had any underlying medical problems, and she told me she had an unstable pelvis.
“Unstable pelvis?” I repeated, hoping the phrase would explain itself.
“Yes, I was doing yoga with my yoga instructor and he made me stretch my leg up …”
“He forced her to lift her leg higher,” the boyfriend interjected, “and the muscle just ripped.”
“Did anyone get X-rays of your pelvis?” I asked.
“No, the chiropractor just referred me to physical therapy.”
“And you fell … why?”
“Because I was weak and I had taken some medications. I stood up and walked into the bathroom and then fell down.”
She paused to scream some more.
“And your butt hurts that much, really?”
“OH, yes,” she answered, “I mean, after all, my pelvis was unstable before this happened. Both sides hurt.”
All right, that did it, I had my diagnosis: This woman was fixing to sue the pants off the yoga instructor. Lawsuit medicine is a phenomenon in the E.R. so common it has a name: Allstate-itis.
As she was wheeled into her booth, Rose’s boyfriend followed me across the E.R.
“Can we get her some pain medicine? She’s in a lot of pain? Could you give her something?”
“Unfortunately, she can’t get medicine until her registration card comes through,” I answered. “She needs to wait just a few more minutes.”
I went into the X-ray room, closed the door behind me, and leaned against it. The two technicians turned around.
“You guys, I’m sorry, there’s this lady out there—HYS-terical. Forty-five years old, healthy, fell in the bathroom, and now is screeeaming in pain. I need you to X-ray both her hips because she says they both hurt. She’s going to make your ears bleed so be careful,” the whole speech punctuated by eye rolls.
I stood next to her boyfriend as the techs wheeled her into the X-ray room, and we both listened to her screams as she was moved to the table.
“She sure seems like she’s in a lot of pain,” I said.
“Yeah, God, she is, it’s just awful,” he said.
Finally I couldn’t take it anymore. “I have to ask you something,” I blurted to her boyfriend, “Is there a lawsuit pending against this yoga instructor?”
“A lawsuit?” he asked, genuinely surprised. “Why, no, we’ve never sued anyone.” With great relief I noticed that he was not offended.
“Well, then, I mean, what is UP? Is she, like, really emotional?”
“No, not particularly.”
I totally believed the guy.
“Man,” I shook my head, “I cannot for the life of me figure out what’s going on. I mean, she’s in a lot of pain. It seems unusual that just a fall in the bathroom would hurt so much.”
Perplexed, I turned my attention to the computer and started checking lab values. I felt a tap on my shoulder.
“She wasn’t kidding,” the X-ray tech said, as he held two films up above my head so that the ceiling light illuminated them. There was no mistaking the results. Two broken hips. Right and left. Both of them.
The X-ray tech and I stared at each other and said nothing. I ran into the X-ray room and leaned over Rose. “Oh my God, Ms. Miller, I am so sorry. Both of your hips are broken. I just, I mean … I had no idea … I have no idea how this happened.”
“Yeah, well, I thought so,” she answered casually. “They really hurt.”
Needless to say, I got her pain medication before she was even taken off the X-ray table, and orthopedics was called immediately to manage her injuries. We sent slews and slews of tests to determine how a seemingly healthy 45-year-old breaks two hips in a mild fall, and she was quickly assigned a bed upstairs to await her surgery.
As my shift ended and they left to go to her room, Rose’s boyfriend tapped me on the shoulder. Smiling good-naturedly, he thanked me, and then with a gentle wag of his finger said, “You should really learn to trust your patients, Dr. Jenny.”
I put on my fluorescent orange ASSHOLE jersey, covered my face with egg, and walked out of the E.R.
