The cases of two young patients, both shocking to me

This is the story of two cases with 5 year old boys when I was working in the ER

By this time I had been working in the Emergency Room for nearly six years and it was one of those maddening Sunday afternoons that go on and on without end. Even after so many years, nothing was routine to me, I still got an adrenaline rush every time I entered those doors.

That afternoon we had seen many patients come and go. They were urgent cases that required stitches or immediate attention for one problem or the other, but at that point, no true traumas had come through the doors. I do remember the labored breathing of a nice little lady who looked to be in her seventies. I saw on her chart that she suffered from COPD among other things. COPD (Chronic Obstructive Pulmonary Disorder) was something my father suffered with for years. He had been a heavy smoker all of my life and then he paid the ultimate price for his choice to smoke.  I remember this patient so well because her name was Sadie (like my favorite sister-in-law) and because she smiled at me through her oxygen mask each time I looked her way. Sadie was admitted to our ICU (Intensive Care Unit) and she waved at me as she was wheeled passed.

My attention turned from that sweet smile of Sadie as I noticed a new patient entering. It was a mother carrying a young boy in her arms. He was 5 years old, limp and weak and a bit sweaty, yet he was adorable with curly blonde hair and sad blue eyes. I was startled by his appearance, he was a very sick child. His nurse got him settled into the pediatric room and drew blood from him for tests that were ordered by our ER physician.

As we waited for his lab results to come over the printer, a call came in from this little boy's father, insisting to come to his son’s bedside. I led him to the room and the second he entered, fireworks began. The father began to scream at the mother and she returned fire. Meanwhile, all I could see was the face of this child who lay there struggling and his expression was one of great sadness.  Through the screaming, I learned that these parents had just gone through a nasty divorce and lots of anger and bitterness remained unresolved.

Our ER physician brought them outside the room and told them they needed to leave that talk outside and concentrate on their son who was very ill. They looked a bit ashamed, apologized and re-entered the room.

As soon as the lab results came in on our sick boy, I attached them to his chart and took it to the physician to review. Unfortunately the data confirmed exactly what he had feared, the 5 year old boy had leukemia. My heart ached as I realized what this child had gone through with the nasty divorce and now what he faced with leukemia. I walked down to the room with the physician. The parents were asked to step out into the hallway for a moment. They were told the diagnosis of leukemia for their little boy.

We stood there in silence as it sunk in and I had no idea what to expect, but I never expected what happened. Suddenly the parents looked at each other and all of the hate seemed to melt away as they embraced one another and wept. They cried, I cried and I looked up to see tears in the eyes of our physician.

Soon their pediatrician arrived and he discussed the case with them and the numerous options they had for his treatment, including a trip to St. Judes Children’s Hospital.  In my mind I recall his curly blonde hair like his mother and beautiful blue eyes from his daddy and the deeply sad look on this little fellow.

Only about 30 minutes passed and it was not enough time to free myself from the sadness of this child, when we were advised another young boy, age 5 was headed in with an injury. We had sketchy details but we knew his injury involved a clothes hanger.
Until I take my last breath, I will clearly see that young boy who came in on an ambulance gurney with his mother that evening.

The mother was sitting up on the gurney with the boy sitting between her legs. She had dark black hair that was in a pony tail and wore a bloody yellow shirt. Her face was engulfed with absolute fear. Her son had thick black hair and wore a bright blue shirt that was covered with blood. Blood was streaming down his face from both eyes and there was a wire clothes hanger sticking in each eye!

This scene was like something from a horror movie and I cannot watch horror movies, yet I could not take my eyes off of the real life horror before me. I remember that mother as she steadied her son and looked as though she could scream at any moment.

This family lived next door to a surgeon and he was nearby when the accident occurred.  He accompanied them in the ambulance and made calls to the needed personnel to rush to the operating room for immediate surgery. So only minutes after their arrival, they were being rushed to the operating room.

The next day we learned that the surgery went well and though damage was done, this young boy was not left blind. He would require aids to help his vision, like glasses or contacts but that was great news to us.

We never know when we get up each day what is in store for us. We must meet it, greet it, and do the best we can with it.

A seriously injured or sick child is a parent's biggest fear!

The case of the LOVE triangle

The case of the Love Triangle

I worked in emergency rooms at two different local hospitals for years and one of the things I loved about working in such a hectic environment was that I never knew what any shift might hold. Surprises always popped up and no two shifts were ever the same.

When I came in to work that night I never expected to be involved in a love triangle but that is exactly what happened.

We had a moderately busy afternoon and things were moving along pretty well. No disasters yet, “so far so good”, are the words that were bouncing around in my head.

There was a pretty woman about 35 years old that was in one of our chest pain beds in the ER that evening. Her name was Mandy and it reminded me of a sweet friend of mine, named Mandy, from elementary school that was one of the kindest souls I had ever known. I found myself thinking of those times so many years before with my friend.

I noticed that our patient Mandy had a male visitor. He seemed so attentive that I had decided he must be her husband. As I worked I glanced up now and then and saw them chatting and laughing like someone attending an afternoon picnic. She did not look anything like the others we had in the chest pain rooms who were pale, weak and had the look of doom as they were in fear. Heart problems can make a person stop and think of the finality of life, but not so with our patient Mandy.

One of the phone lines at my desk began to ring and I never expected who would be on this line. I answered, “Springhill Emergency Room, how can I help you?” It was a well spoken young man who said he was calling to inquire about his wife who was a patient of ours. He said her name was Mandy. I advised him that the only thing we could tell anyone over the phone was whether the patient was stable or not. I confirmed that Mandy was stable. He said, “Well I am in the waiting room, can I come back to see her or do I need to wait?” I assured him I would come out there and get him when she could have a visitor.

I immediately walked to Mandy’s room and told her that her husband was outside and he wanted to come back to see her. She casually said, “Wait, I need you to hide my boyfriend first.” She said her boyfriend and husband knew each other and big problems could happen if her husband saw the boyfriend. I quickly escorted the boyfriend down a back hallway and asked him to wait there until I came back to get him. I did not feel good about it, but I did not want there to be an altercation in our ER.

Then I went to the waiting area and escorted Mandy’s husband to her bedside. Her husband looked so worried and concerned about his wife, who by then had a completely different demeanor. She was not laughing and freely chatting while her husband was there, she had the appearance of being in pain and weak as she lay there.

After about 20 minutes, the husband stepped to my desk and said that he was going home at his wife’s insistence. He explained that he had pulled a double shift at the paper mill and needed to bathe and rest, then he would return. He added "Mandy is so sweet, she wants me to go home and rest." He smiled as he said for me to take good care of his wife. I smiled back and nodded.

Once the husband was gone, I retrieved the boyfriend from the back hallway. 

A couple of hours passed and the lab work results came back to reveal that Mandy's problem  was not cardiac related at all. She was constipated. She looked embarrassed a little but I am sure she must have been relieved to know it was not a heart problem. She and her boyfriend continued their visit and moments later, Mandy’s husband returned. He said he felt that he needed to be with her, dirty or not, because she was an ER patient with heart related issues and his place was with her. He had gotten down the road a bit and decided to return because he loved her and needed to be with her. Again I asked him to wait a moment and advised I would come out and get him soon.

I walked into Mandy’s room once more. I told her and her boyfriend, this juggling act was not going to continue. I was not going to shift these two men back and forth anymore. I suggested the boyfriend leave the building via that back hallway and I advised I was going to let the husband back in a matter of minutes.

The boyfriend left, and I escorted the husband back to Mandy’s room. As I was leaving her room, I heard her say to her husband “they found some issues with my heart and they are going to discharge me anyway”.

He came to my desk and asked could he speak to the doctor who was seeing his wife as he was very concerned that she was being discharged like this. He appeared to be angry. I called back to the ER physician who was handling Mandy’s case, I gave him an earful of what had been going on and he came out immediately to speak with Mandy and her husband.

Our physician told the husband straight forward that Mandy did not have a heart problem at all, her diagnosis was constipation. Furthermore, she had already been informed of these details. Mandy laid there in silence and the husband apologized for getting upset.

She was prescribed a laxative and released back out into the world. I have no clue where her boyfriend went but I felt sure she would see him again soon. It was the tangled web of a love triangle that Mandy had weaved for herself. For me, there was no surprise that her problem was not her heart, I wasn't sure she had one.

The case of the travel toothbrush holder

Case of the man who packed his toothbrush holder

Everyday that I worked in the emergency rooms was a pleasure. The work was often hectic and tiring but the adrenaline rush was amazing. It is a job I will always remember.

This Friday evening shift was a doozy. There were people lined up in the waiting room. There was standing room only when I peeked out to check. I remember thinking what an interesting crowd of people. Some were cut, bleeding and waiting for stitches, others had all sorts of sick and miserable looks on their faces. To me it was a picture of the shift that was just beginning and would be filled with surprises.

An older couple caught my eye. She had such a sweet look about her and he looked like a real grump. But I reasoned that perhaps he was ill, so I felt bad that I assessed him so negatively.

It took almost 2 hours before I saw the older couple come back into the ER. He was a foot taller than his little wife and weighed over 200 pounds. His skin was marked with the brown spots of aging and the scars of acne from his younger days. He did not and would not smile for anything. Shortly after he was settled into his bed, he told his wife to go and wait in the waiting room. To me that was an unusual request, but people are strange. She complied and smiled as she walked back out into the waiting area. She was only about 5' 2" and 90 pounds and she hunched over when she walked.

It turns out he had a problem that he did not want his sweet little wife to know about, so he sent her out so that he could talk to the physician in privacy.

His chart said he was having abdominal pain. For a brief moment I thought “uh-oh”, then I realized his age. Abdominal pain was the normal complaint of men between the ages of 25 and 45 who came in with "misplaced items" in their rectum, but this man was 68. 

We often had people come into our ER with items lodged in their rectums and most pretended they had no idea how that could have happened. 

This patient was sent to radiology for an x-ray of his abdomen. When it came back we were all surprised to see that he had a plastic travel toothbrush holder lodged in his rectum. He was advised that he would have to go to the operating room to safely remove it without damaging his rectum. He said that was ok, he just wanted it out as soon as possible.

I walked passed his room and he called me to his bedside. He spoke in a whisper as he made his request. He said, “Tell my wife that I am having hemorrhoid surgery.” 

I explained to him that I could not lie to his wife, but he was welcome to tell her anything he would like. He was not very happy with me but I did what I had to do, it would not have been ethical to lie to this man's wife. He then said,"I did nothing wrong!" He added “I was only experimenting!” 

Those words stuck in my head for weeks, months and years. Even today I occasionally think of his words that day. My idea of an experiment is the process of performing a procedure to determine a result. I have thought about this patient many times and I do not know what kind of experiment it is to put a toothbrush holder in your rectum. I suppose that is one of those things in life that will have to remain a mystery.

This man’s family gathered as he waited to be taken to the operating room. His grown kids were concerned and loving as well as his wife. He was surrounded by people who loved him and cared about him. That was a blessing. 

The process went well and everything came out ok.

 

The case of True tragedy and loss

It was Tragedy and loss...

In the years I worked in the emergency rooms, I saw a little bit of everything and I learned so much about people.

When some families were advised of the death of their family members they showed no emotion at all. Some wept deeply and silently. There were those who screamed and shouted,  still others went completely berserk. 

One summer afternoon when the temperatures reached record highs, some young boys decided they wanted to go for a swim. In there neighborhood there was an old abandoned pool in a city park that had been closed for years. There was a fence that blocked access to it, but that did not stop these guys. It only took them moments to scale that fence and jump right into that murky water.

There were 6 or 7 young boys in the group and they got into trouble quickly as none of them knew how to swim. The call came in to our ER that we were getting 3 possible drowning victims. The others were dispersed to other hospitals. 

We got 3 patients, 2 of them were brothers ages 9 and 11. The third was their first cousin who was 10 years old.

Our physicians and nurses worked as hard as any group of people I have ever seen, to try to revive and save these precious children. Unfortunately by the time we got them there was little, if any, hope of recovery. One of the boys responded and was clinging ever so slightly to life. He was the cousin. The two brothers never came back, they never were able to respond to the tremendous efforts that were put forth to save them.

They were beautiful children with such angelic faces as they lay there innocent and no longer alive. When our crew went back to the conference area to advise the family of the death of these two boys, it was like a volcano of emotions erupting. These people jumped and screamed and hit the wall with their fists. They were hurt, deeply broken and angry at a world that could take their innocent babies out. After a long period of raw emotions, we had the boys ready for them to come and say their final goodbyes. The tubes and IVs had been removed and they lay there side by side in the code room where so much death takes place. There was a series of curtains that ran on tracks in the ceiling and circled around the gurneys where they lay. When the huge family including parents, grandparents, aunts and uncles, entered that room, all hell broke loose as they looked at the devastating sight of their beloved little boys. They ripped the curtains completely off the tracks and threw them on the floor. They punched the walls and flipped over tables that were filled with instruments. They slammed everything off the counters nearby and pushed and shoved the staff that was there. We were also grieving the loss of these children and our staff had fought so hard to save them. One of the uncles grabbed the oldest boy up and kept screaming “come back, come back to me!” “We gone play some football, you gotta play Derrick, you gotta play ball for me again!”

This uncle was their football coach at the nearby park and his painful cries tore at my heart as tears streamed down my face. I did not know anyone involved but I felt their pain of loss.

I will remember that day and the tension that was thicker than any I had witnessed before. These people were feeling an enormous loss and they did not know how to control their emotions and despair. My heart went out to them as they wept and screamed for such a long time. We backed off and gave them time to work it out.

I remember reading about this event in the paper the next day. It said that in all, 4 boys lost their lives that day. One was barely hanging on and his future still looked bleak. Two were treated and released. I am sure that everyone questioned themselves about what they could have done to prevent it but it was too late for those thoughts now.

This was a shift in the ER that hung on my shoulders and laid heavy on me for weeks as I passed by the code room and saw it all play out again and again. It was sadness unlike any you could imagine.

The case of the Shouted Deathbed requests

It was a Tuesday night and I was working all night at a local emergency room. It was a job I dearly loved. So much emotion went along with the hours spent there. There was laughter, sadness, horror, heart break, insanity, and enough compassion to last a lifetime.

This night I would meet a person and experience something I never could have dreamed or expected to happen in my life.  Memories from this shift  repeat themselves in my mind at times and each time it does, the goose bumps pop up and the hair on my neck stands up just as it did on that night years ago.

He was in his mid fifties and an ambulance brought him in close to midnight that night. He was in the midst of a heart attack and he was alone. His family had left for a trip two days earlier as he had remained at home to complete a project for his employer. It was a huge project that had monopolized his time now for months. Soon it would be complete but he could not afford to abandon the project to join his family for the trip.

When he first came in and was settled into our chest pain center in the emergency room, he was very anxious but he began to calm down a little. 

I walked in to ask him a couple of questions for our records and he seemed to be in deep thought as he popped out the answers to my questions. We spoke for a little while as he seemed so eager to talk to someone. He was telling me of his life and about his family and it was clear he wanted me, or someone, or anyone to know his story. He looked reasonably comfortable as he spoke of his wife and teenage son and daughter. His halting breath was concerning but he was pushing through it.

Suddenly, he shouted “Write this down, write it down NOW!”

“Tell my wife (Anna)”

“My records are in the safe in my bedroom. Look in the blue briefcase for the updated insurance papers. Sell the house, buy Julie that car she wanted. Look after mom. Don’t be sad Anna. Please forgive me!”

“Tell mom that I love her and she was a great mother!”

“Tell Julie, that daddy’s proud of her and his love will always be with her!”

"Tell Joey he's now the man and I need him to....."

That was the end of the shouts, he seemed to completely run out of gas. He went from 80 miles per hour to zero in an instant.

This patient was dead within 10 minutes of his screamed orders. It was difficult to  write but I wrote furiously to get it all down. I will never forget the fear and regret in his face. It was enormously disturbing.

Everyone in that room was shocked. Those working feverishly to save this patient, had heard every word just  before they performed chest compressions. Then one of the nurses noticed on this man’s chart that he had requested DNR (Do Not Resusitate). After his heart bypass surgery a few years earlier and his subsequent heart attacks, he had elected to not go through the process of intubation and prolonging the inevitable.  

As he laid there he looked so young to me. His light had burned out and there was no changing that. I did not know him, yet I felt deeply connected to him in that moment as I held those instructions I had scribbled in haste for this dying man.

This was an experience that was unique. We heard a man in a panic who tried to say what he could before his last breath, and last heart beat. It was eerie and it was deeply moving. I only knew this man for minutes but he effected me and he taught me. I saw first hand how it looks and feels when your life is over and you suddenly have so many regrets.