He was a fisherman all of his life,

Mr. Nguyen

It was a slow day, which was rare in our ER. I loved working there and I had learned early on that you should cherish the slow times because they are like rare jewels that don’t come around often.

We made a fresh pot of coffee and talked about some of the cases we had seen the day before. Then we asked one of the single nurses how things were going in her love life. Most of us were married and it was just a good thing to hear all of the craziness there was in the single life out there. To me it was about 15% exciting and 85% scary to listen to the stories of how strange and twisted “dating” had become. There are many different scenarios now in the single life. There is single dating single, single dating married, single dating same sex, single in a “friends with benefits” situation, then it drops to sex with strangers for the thrill and even worse. So, I was the oldest person in the group at the time and as I sipped my coffee, I made every effort to “remain calm”, just like you are told to do when you get snake bit. Few things surprise me but some things I heard that afternoon did just that.

I do not judge how anyone lives their life, I feel it is your life, you should decide how it is lived. I may question (in my head) some of the choices but I truly am not judging. We each see life differently. We received a call on the ambulance phone and knew they were heading in with a person who had chest pains. Our brief, “slow” period was over.

Now we also had a patient who was brought to Bed 6. I knew by the bed placement that he was pretty sick, though he was walking on his own power. He was an asian looking man with very tan, tough looking skin. His dark straight hair poked out from under his Guy Harvey fishing hat. When I saw his last name was Nguyen, I knew he was Vietnamese. Some of my dearest friends are in the Nguyen family, but I had learned that this name in Vietnam is similar to Smith in America, and it was unlikely they even knew each other.

He was a fisherman all of his life and had hired onto the crew of a large fishing vessel. Deep into the Gulf of Mexico they traveled just as they had done many times before. They were out for weeks at the time, the pay was pretty good, the adventure was what he loved, and the risks he was willing to take.

This patient was very sick. He had been out for two weeks on the fishing trip and only a one day before returning, he got a huge hook deeply lodge in the back of his hand. It had swollen to the point it was hard to tell it was a hand. There were dark red streaks running from his injury. He was feverish, and he had chills. 

Mr. Nguyen was a very pleasant and humble man who appreciated the care and attention he was receiving. He knew he had a bad infection and he felt he had foolishly reached out at the wrong time and caused his own injury. He said that he knew instantly this would be really bad. He even said something about the way this hand felt, caused him to think he might die.

It was not long after the infectious disease specialist arrived that he knew he was in trouble for sure. It was something called Vibro Vulnificus, more commonly known as a “Flesh-Eating Bacteria”. Within a few more hours he was in the operating room where they amputated his hand and part of his arm. This had to be done to save his life.

Through it all this sweet man was pleasant and happy to be alive. There was no pity party or no complaints from this man. 

I was so thankful that it had been caught in time to save his life. I heard that he found a way to continue his fishing and his life is as close to “back to normal” as it could be. One day several months after this ordeal, Mr. Nguyen and his wife brought flowers to us as a token of their appreciation.

I can close my eyes and see Mr. Nguyen on the boat, fishing with one hand and happy to have that ability. I love to see a man who works hard and loves the work that he does.

He was one of those good people that you are glad you could help.

His ship came in

The ship from China was in Mobile.

It was the middle of the afternoon on a Thursday and it was the normal crazy mad rush of people coming in to the ER. I loved my job and the excitement never ended, there would be short lulls of time but overall the flow was continuous of sick, hurt, injured people. 

The hospital where I worked at the time had an agreement with the shipyards downtown to take patients who came in on ships from foreign countries and there was a liaison who always accompanied them. Unfortunately this liaison could only speak english. 

This particular day a chinese gentleman was brought in with an injury. He had smashed two of his fingers on his right hand with some kind of equipment he was using on the ship. Both fingers were totally as black as tar and the skin looked like leather, there was no sign of life or appearance on those fingers of anything looking like human flesh. He did not speak english and when Dr. B saw him, he determined the patient needed surgery immediately to remove these fingers. 

Dr. B began an effort to tell him what needed to be done and how important it was to do it asap. It was almost funny as I watched our doctor; he looked like he was playing charades and was very animated in his efforts to explain. But the patient would stand and motion that he wanted to walk out. It was like watching one of those silent movies, they were acting out their conversations and it was interesting to watch. I believed that both understood what the other was saying to a point but there was a piece of the puzzle missing.

In the midst of all of this Dr. Schulte, a local physician with Pulmonary Associates came walking up to my desk and asked what Dr. B was doing. I explained the guy was injured two days ago on a ship from China and Dr. B was trying to tell him that we need to amputate his dead fingers, but the man only speaks Chinese. The patient appears to want to leave.

Dr. Schulte stood there, thinking. He is a very clever man and he is very funny. When he told me to call the China Doll Restaurant, I was confused. I thought he was just being silly and acting like he was going to order food or something. Then he said, tell them I want to talk to someone there who speaks both english and chinese.

Soon I had a very nice lady on line and Dr. B. brought the patient over. He explained to this lady how important it was that the man from China stay and have surgery to remove these fingers. Then he handed the phone to the patient, who began talking fast and animated. I did not think he would ever be through telling his story to this chinese lady at the restaurant. Finally he handed the phone back to Dr. B. She told Dr. B that the patient said he has family in New Orleans, which is the next port for his ship and they are going there tomorrow. He wants to wait until he is with family to have this done and he vowed that if they would allow him to go back and catch the ship before it left our port, he can meet with his family tomorrow, go to the ER in New Orleans, have the surgery and have family at his side. Dr. B. agreed to allow that with his sworn promise.

This once frustrated, upset, almost angry and confused patient looked like a different person at this point. He was calm and happy as he signed the discharge papers and took the envelope with our physician’s notes. Then off he went with the liaison to catch his boat that was headed to New Orleans.

I do not know how Dr. Schulte thought of calling a Chinese Restaurant. It would never have crossed my mind. He is a very humorous man that kept us in stitches when he came through the ER late at night. Yet he is a great pulmonary physician with compassion and a sharp mind. I think he deserved an award for this one.

I thought about the services we have at our disposal for translations in cases like this, but I realized that this call to the China Doll Restraunt worked so much faster and more efficiently; good call by a great physician.

Two days later, Dr. B. got a call from the surgeon in New Orleans who advised the surgery was done and the patient should do well. 

At  dinner time on that shift, we ordered Chinese food to be delivered to the ER. There was shrimp fried rice, crab rangoons, egg rolls, chicken chow mein, and we did our best to eat it with chopsticks in honor of a different culture....soon after the eating commenced, you could hear, “give me a fork”, “where is a spoon”, “I can’t handle these chopsticks!”

One Thumb Down

One Thumb to Go

It was 6:00am and things had calmed a bit in the ER. I knew that it would only be a short while until the morning rush began, so I took advantage of the moment of silence to pour a cup of coffee. Somehow coffee is soothing to the soul, at least to my soul.

I saw a young woman escorted over to one of the laceration beds. There was a group of 3 beds that were primarily used for patients who needed stitches. Sometimes they were used for whatever we needed but cuts and gashes were normally in these beds. I looked at this woman and something in my heart felt very sad. She was bone thin and so unhealthy and unkempt looking. She wore very tight dirty jeans and a very faded t-shirt that said “AC/DC” on front. My thought was how did such a thin person find jeans that tight. Her hair was light brown and appeared to want to stick out in every direction with little control. She seemed to be very nervous as her big brown eyes darted about as though she was being tracked by a tiger or something.

My attention was turned to the telephone as a call came in from Cardiology Associates for Dr. M and I got him to the phone. It was for a chest pain patient we had been holding all night. I was certain they would be taking him to the Cath Lab this morning.

My mind and eyes quickly turned back to the young woman in the laceration bed. She was sitting up on the bed even though her nurse had left her laying down. She was rocking back and forth with an erratic rhythm and I was fascinated with her demeanor.  I knew from her chart that she had something wrong with her thumb on her left hand. Unlike most patients who had lacerations, there was no blood dripping nor bleeding through a make shift bandage. 

Dr. M. picked up her chart and headed her way. She didn’t seem to be cooperating with him as he tried to get information from her. He was trying to determine how her thumb got injured and she refused to answer. The thumb was in really bad condition, so much so that Dr. M. asked me to call the on-call surgeon. 

When the surgeon arrived, he was familiar with this patient. He had taken care of her about a year earlier. He talked blunt and boldly to her. He said, “so you are at it again I see!” She peeked up at him then ducked her head down like a small child who was being scolded for jumping in the mud puddles.

The surgeon asked that we call the operating room and get things set up for this patient.

He was going to have to amputate her thumb. I stood there in shock. Amputate her thumb, was he for real?

Then I heard him say, "Gina, I know how you burned that thumb so bad". "Holding that hot crack pipe", he added. "I told you this was going to happen the last time you came in, didn’t I?”  She sat there meekly staring at the floor and nodded in agreement with his words.

I had the Operating room staff on the line and the surgeon came over to speak to them. I walked over to her bedside and asked Gina if there was anyone she would like me to call before she went to surgery. She just shook her head and her hair covered her face down over her eyes but she made no effort to move it. I looked at the thumb and it looked really bad. It had black spots on it and looked almost shriveled. I stood there for a moment and then asked, “Are you sure you don’t want me to call a friend or relative before you go to surgery?” She never looked up again but she said, “No, they wouldn’t care and I ain’t got their number anyway”. I noticed she had pimples or bug bite marks covering a lot of her face, arms and legs. It looked like she had slept outside and mosquitoes had just stung her for hours, yet I was not sure how these marks were made. It was painful, of that I was certain.

I have to tell you I felt so sorry for this young lady. Not because of the situation of her surgery, not because of the marks on her, but for the sadness and emptiness I felt coming from her core. Perhaps she brought it on herself. She may have had wonderful, caring parents but chose the wrong path in life or more likely she may have had no one who really cared to teach her right from wrong. At this point in time how she got here did not matter that much, the fact that she was in this situation was very sad.

When my shift ended and I headed out the ER doors I thought of her. When I showered and headed to my waiting bed, I thought of her. I tried to fall asleep after that long night shift; yet Gina’s sad eyes and poor health disturbed me. Equally disturbing was the fact that nobody cared about her, or at least that is how she viewed it. 

Eventually I convinced myself that this was one of those situations over which I had no control. She was a lost soul whose life was valued by no one, not even her.

I can only hope that Gina healed well and turned her life around. I can only hope that she found safety, sobriety and joy in her life. I have a difficult time believing it ...yet 

I can hope.

A truly BAD day

Painful to witness.

He hung there lifeless, now all of his  troubles seemed to be behind him.

What about his mother, didn’t he know she would be the one to find him like that?

I don’t believe he thought passed his death and into her life without him. He came in one night by ambulance when I was working in the ER of a local hospital. It was years ago and I wonder how his mother is doing today.

The ambulance service called to let us know they were 6 minutes away with a 17 year old male who had attempted to hang himself. Based on the report they had given it did not look like there would be a good outcome.

It seemed more like 3 minutes when the ambulance bay doors flung open and they came rushing in with the gurney while doing CPR. It was just like you see on TV but it was REAL. The young man was very pale and lifeless as they headed to our Code Room with him. I noticed his hair was blonde and wavy as they passed me. I knew from the report that he was only 17, so my heart was pounding with the hope that they could revive him since he had so much living left to do.

Moments later I was notified by our registration desk that this young man’s mother was here. I hurried out to get her and took her to our “grief room” so that she would have some privacy and so that the physician on duty would know where to find her. She was shaking all over and her words were halting as she spoke. She wore a beautiful black dress with a bright yellow jacket. I could tell that she was once beautiful but it looked like the years had not been good to her and of course she had eyes that were very sad and filled with tears.

She wanted to talk and she wanted to know if they were able to revive her only child. I told her I would check to see how it was going and return to her shortly. She nodded as she took a seat.

I walked to the code room and I could see that they had stopped CPR and were determining the exact time of death. As I took in the whole picture, I looked over to the patient and tears began to pour down my cheeks without control. I immediately felt the sheer sadness and loss and then my thoughts went to the mother who was waiting for news as I am sure she hoped for a miracle.

Our physician looked like he had aged years in a matter of minutes as he looked up and asked me where the family was and I told him. He said go tell them I will be there shortly. I walked to the grief room and told her the physician would be with her in a matter of minutes to give her some information.

As he entered the room, our physician took a deep breath. I held her hand and he spoke the words that no mother ever should hear. She sat there ever so long in total silence. I looked up at Dr. B and he looked at me, it felt as though we were in an empty space without sound, without air, completely void of anything in those moments as we waited for her response. Then as we had settled into the total silence she began to scream the most blood curdling scream I have ever heard. As I type this it comes back to me and it feels like it was minutes ago, I have chills as I recall that place and time. I held her and hugged her and tried to comfort her but there was no comfort for times such as this. We let her scream it out and when it fell silent again, I asked was there anyone else I could call (in my mind I was thinking what about his father).

She slid from the chair to her knees and said her husband had died in an accident and his funeral was earlier that day, they had just come home when her son went to his room. She gave him some time to be alone in his grief. He and his dad had always been very close and did everything together, he took it hard. When she went to his room, he was hanging from the light fixture.

I had seen and heard so many things in the years I had been working the ER, but this one tore me up. Even Dr. B who is usually pretty stoic was wiping his tears away when I looked over at him.

From that day on, when I start to think I am having a bad day, I think of this lady and I immediately know I AM NOT HAVING A BAD DAY AT ALL!

She was sweet, sad, lonely and...

She was ALONE...

It was just after midnight and things had finally begun to slow in the ER. We still had a near full house with only one fast track bed and one chest pain bed remaining available at the moment. (Fast track beds are used for people who can be “fixed” and released pretty quickly, so those beds are patients who go in and out in less time than others. Of course there are some cases that fool us at first glance. When they turn out to be more involved it usually necessitates us moving them to another bed for extended care).

This sweet elderly lady walked through the doors, escorted by a nurse. She looked frail and walked slow while refusing a wheelchair. As she pulled her head up to see where she was going, she saw me and tried very hard to muster a smile. She wore a pink and pale yellow print dress that was cinched at the waist with a gold belt. Her shoes were sensible ones with flat heels and a strap to hold them in place. I guessed her age to be late seventies and I wondered what was going on with her. She touched my heart at that moment as I could see her misery and hoped it would be resolved soon.

Dr. M went in to check her out and stayed longer than usual. He ordered a whole gamut of tests and I was inputting them for him when I looked up to see her lying there. She looked weary and she looked so tired. Something about her held onto my heart with such a grip I had difficulty thinking of anything else.

Minutes later she asked me for something to drink, her preference was sweet tea and I advised her that patients cannot have food or drinks until their lab work is back. She nodded as though she knew the answer and her look was one of total hopelessness. About that time, Dr. M came passed and I asked him (just in case she could be an exception to the rule). His answer was no, nothing by mouth (NPO is the term), until we get some lab results back. We were close enough to her bed that she heard the conversation and I caught a view of her as she nodded in acknowledgement of my effort.

I had a sippy cup on my desk, full of diet coke but I slid it over out of sight and even though I was very thirsty, I would not drink in front of this precious person who could not have a drink herself.

This patient’s name was Elizabeth and I still remember glimpsing at her as she lay there, so worried, so thirsty and scared. I wanted to hug her but I knew that would not really be appropriate so I turned back to my work at hand.

The faded out old hospital gown she now wore, did not hold a candle to that dress she had on moments earlier. I remember hoping everything would come out fine and she would be back in that dress shortly and headed home. Yet I knew in my gut that would not happen.

The results came back slowly and some of her numbers were so out of whack that the lab called them in as critical. I advised Dr M as I received them. He had sent her for a CT scan  with a request that it be read by a radiologist asap. It seemed like forever, but now the radiologist on duty was on the line waiting to discuss the results. It turns out there was a large mass in her chest cavity which also involved part of her left lung.

It appeared that Dr. M hesitated as he headed into her room, maybe with a feeling of dread with the news he had to deliver. He came out looking even more burdened and I could see Elizabeth as the tears flowed. It was a near certainty that she had cancer and Dr. M felt sure it had spread. She would be admitted to the hospital and more test would be ordered plus the on-call oncologist was called.

I caught up on my work and I went to her bedside. I took hold of her hand and just held it without speaking a word. She squeezed my hand and held on tight; then she began to speak of her life.

She told me "I had loving, devoted parents who gave me a life right out of a storybook"

She had never married and she had no children. Elizabeth was an only child, and had only one distant cousin from one of her father’s siblings and he lived out of town. She had no one except a couple of co-worker friends and did not want to disturb them this time of night, if at all.

She was 83 years old and still working full time as a secretary at a construction company in town. She was very faithful to her job, it was really all she knew and all she had to cling to these days. When she realized that she would be admitted, her only concern was that payroll had to be done the next morning and she could not miss work.

Dr. M. assured her that someone would do that in her absence and that she absolutely could not make it to work. 

The next day when I got to work, I checked with the secretary on her floor to see how she was doing. She had signed a DNR sheet (which means Do Not Resusitate).  I had planned to  find a moment to check on her, but by the time it slowed down in the ER, and I tip-toed to the door of her room, she was sound asleep. The next day, I checked with the secretary again on the floor where Elizabeth had been admitted, she said "she is resting right now". I learned that she was being discharged to a hospice across the street from our hospital. I decided I would visit her there the next day on my way in to work.

The following day, I was so excited that I almost skipped as I headed in the door. I walked into the hospice at 5:00pm about an hour before I had to be at work across the street. It was like the wind had been knocked out of me when I was told that she passed away early that morning. They told me her only visitor and only contact number was her boss and he had been notified.

I sometimes think about Elizabeth. There is no way for me to imagine being in her shoes. I have almost too much family, if that is possible. It sure made me stop and realize how very wonderful it is to know there are people walking this earth that share my bloodline and have an automatic feeling of connection. To walk in Elizabeth’s world was to walk in such a lonely, scary place with no safety net and no soft place to fall.

I get a chill just thinking about how that must feel.

Big guy, missing something important

Shortcomings

I worked for years in two local hospital ERs and I have lots of memories that are vividly etched into my mind from those years. Many of those are some of the saddest, gut wrenching experiences imaginable as I cried with families who lost someone they loved, even though I did not know them, I could feel their pain. On the other end of the spectrum there were funny, hilarious and ridiculous times as well. The ER provides the full range of emotions. 

Oddly, this case was sad but also funny and it was an eye-opening experience.

It was an exhausting shift, yet exhilarating as we were seeing a little bit of everything that night. There was blood, guts and gore aplenty which can make a person reach for relief of some kind, any kind.

We had received an ambulance call about a 30 year old man who was coming in who had attempted suicide. These were always sad cases that cause me to think what would make a person want to end their life, especially someone that young who has most of life right there in front of them.

Here he was coming through the doors on the gurney. I saw his huge feet first, one was uncovered as they wheeled him in. This guy was well over six foot tall and his hands and feet were huge. We were so relieved to see that he was in pretty good shape. He had taken pills enough to do the job but called for help immediately after. This had enabled us to take the measures available to prevent any real serious consequences.

Our patient was saved from the jaws of death I am happy to report. Let me tell you the whole  story.

Charlie, is an ER nurse that is so funny, he has a huge sense of humor and I loved working with him. Charlie finds humor in everything.

I will NEVER forget that night. It was moments after his arrival and we had all hands on deck holding this patient who was thrashing around incoherently after having taken the pills to end his own life. These experiences are traumatic and serious and that is magnified when you are right there in the situations, touching it, feeling it and hearing it all take place. Well, I was holding this patient’s left leg and Charlie had the right just to maintain some order as his clothes were being cut off and others were trying to get him settled down.

Just as the pants were removed, we could see his private parts, which is not even shocking to us anymore because we had seen everything over the years. Seeing someone's “junk” as they call it today, is no big deal. But it was a real surprise this time. It was almost freakish to see his genitals. It was difficult to know whether he was a male for sure as his penis was extremely small, smaller than that of a 2 year toddler. It was shocking, sad and everyone was silent at this strange sight.

As I stood there, Charlie leaned over and said, “Oh my God, Juanita, I now see why he attempted suicide!” While I know with every inch of my being that was totally inappropriate, it was suddenly so funny, so wrong, so insensitive, so everything wrong; and we all laughed, it was a tension reliever for an odd situation.

It was moments after that when I actually looked closer at the patient’s face and I had another shock, it was my neighbor. That was 8 years ago and I am ashamed to say that even now when I see him at the mailbox or pass his house as I take a walk, ALL my warped mind sees is that sight we saw in the ER. Forgive me but I cannot control my mind when it comes to "seeing" my neighbor. 

So many things are clearer to me since that night. His wife has always been a grump; she complains about everything. I will be a lot more tolerant of her complaints in the future. They have no children; this is definitely understandable. 

I learned so much from this experience. I always thought a big man especially a big man with big FEET and HANDS, had a big EVERYTHING, if you know what I mean. I now know that is not always true. It makes me question everything I thought I knew to be true.  

I have to say that my new view of my neighbors was unclouded, it was now crystal clear why these two were dissatisfied with life and seemed to be so unfulfilled. It has made me a better neighbor, one with great compassion for a very SAD situation. 

Since that time when I meet a couple that seems disgruntled I have so much empathy as I wonder, is there some “shortcoming” that has caused this?

3” wire vs man

I was sipping on a great cup of coffee when they came in to the ER. He was clearly in pain, slightly bent over from the waist and she had her hand on his back and a worried look on her face. He was in his sixties with dark hair that was heavily sprinkled with gray and even though he was hurting, he glanced up and managed a smile. She was carrying some extra weight and carrying a huge purse that had magazines peeping out from the top. I guessed her concern for him was so great that she was unable to manage a smile.

She said that she thought maybe he had food poisoning or something. She had never seen her husband suffer this way. “He is as tough as nails and it is scary to see him in such a mess.” Then she added, “Can one of y’all keep an eye out for our son, he is on the way down here?” I assured her we would.

This patient was hurting so bad that he found it near impossible to lay still, he was moving about as though he wanted to find a position that was less miserable but the position was no where to be found.

Shortly after the ER doctor saw him, he was whisked off to get an xray.

Then I turned my attention to a little girl was being taken to our ear, nose and throat room. She had pushed a sizable piece of chalk up her nose. I don’t know what is about kids but for some reason, they find a hole on their head and they shove something in it. We frequently had patients with things in their noses and ears. Usually these patients are 5 years old or younger. This young lady was 3 and she had a piece of pink chalk lodged deeply in her nose. It had caused her some discomfort and scared her mother so here she came, big smile, huge blue eyes, pigtails with pink ribbon and holding her American Girl doll tightly.

Our patient with the pain in his lower stomach was back from xray and he still looked so very sick. It was laborious just to look at him. The xray was a big surprise. This man had a wire about 3 inches long in his intestines. We later learned after his surgery that it had poked a hole in his intestines and had caused the contents to spill out into his abdomen.

It was now inflamed and he had peritonitis, which is very serious and life threatening.

The surgeon who  worked on this patient told us it was one of the worst he had seen. He said “That man is one tough cookie.” 

A couple of days after his surgery after discussing the wire with his physician and looking at it, he realized it was one of the bristles from the wire brush he uses to clean his grill. It must have been on the grill when he threw his burgers on there a few days earlier and it cooked into his burger. He eats fast and remembered feeling a scratch when he swallowed a big bite of burger but didn’t give it a second thought.

Every time I have seen a wire brush near a grill since then I think of this precious man and what he went through. I am so proud that he survived but it was touch-n-go for a while. 

None of us know how this glorious ride will end. We do careless things as we live our lives the best we know how. Who would think a 3 inch wire could be life threatening?
This was a good man with a nice family and I am thrilled it had a happy ending.

Time to mow the grass?

Every shift I worked in the ER was an adventure. I would grab my lunch and head out with anticipation in my heart and a big grin on my face.

This was a Saturday night and there was an event in Semmes, Alabama that was likely to cause injuries, so everyone was talking about it. Its a small town just outside of Mobile, Alabama. Semmes is a rural community that consists primarily of farms, dairies and flower nurseries. They are a tight-knit group of people who support their high school football team on Friday nights at Mary G. Montgomery High School. They appreciate a good competition and had begun having lawn mower races. This night would be the first full-fledged organized, sponsored race so the whole town was a buzz about it.

We realized that anything called a lawn mower race would probably include ER visits, so we were ready. 

Our ER was busy without the race, so we were running and putting out fires as we tried to care for the patients we already had, while in the back of our minds was the vision of victims of wrecks from racing lawn mowers.

It wasn’t long until we got our first injured person from the very first lap of the very first race. It was a young man about 19 years old who had suffered a tip over when he was in a curve at too high a speed and he was thrown from the mower as it tipped and rolled over several times. Unfortunately when he was thrown, it was right in the path of another mower, he scooted and scrambled and was able to lessen the blow, but he still caught a pretty hard lick that broke his femur (the large bone in the upper leg). He was in some intense pain as he arrived.

Xrays revealed just how devastating that break was, it was through and through with a jagged break, it was  a nasty injury. That poor young man was asking for his mother, but the person who came with him explained that she had gone with his younger brother who was also injured and was taken to Providence hospital a few miles away.

He was a great looking young man with some deep scratches on his face that contained dirt and trash. Those were being cleaned as he winced from the sting of it all. His hair was jet black and it hung in curls that bobbed up and down while the techs scrubbed and cleaned his wounds.

About an hour after he arrived, we got another young man who had fallen from his mower and had a serious concussion. He was quickly sent for a CT scan of his brain. I remember watching them roll him in, he had sweaty blonde hair that had hay protruding from it and lots of freckles dotted his face. His left arm that hung from the gurney was covered with freckles as well.

I noticed his name was Toby, I always loved that name. I said a silent prayer that Toby would be ok. 

We received a third patient that night who had a gash on his leg from his accident during the race. It took 48 stitches to close that gash. He was the toughest 14 year old I had ever seen. He sat there watching and slightly wincing as he felt the sting during the process. He gritted his teeth but no tears ran down his face. This young man had the biggest brown eyes and a sweet smile. He was well mannered and appreciative of everything our staff did for him.

Mrs. Carmichael came in and asked about her son with the broken leg, he was the first patient we had received from the lawn mower races. She was upbeat and very talkative as she talked about these races and the injuries her three sons had received. She had this one with the broken femur at our ER and two others across town at another hospital. Their injuries, were thankfully less serious than the one we had.

It turns out that she just loved these races. The excitement was a thrill for her. She was not happy that her sons were injured but she was talking to this one about needing to heal before the next race coming up in the fall. I couldn’t believe my ears.

As I processed the whole situation in my mind, I realized we are all different in this world and that is a wonderful thing. There are risks of injury in almost anything we choose to do in life. Even with that in mind I was so happy that my sons never had any interest in lawn mower racing. We needed that lawn mower for the grass.

I was thankful that all of our patients were expected to have a full recovery. 

We are funny creatures and it is wonderful that we all have our own interests and our own desires, who am I to judge what is the right choice for others. It's hard enough just deciding for myself.

A brush?

Where’s my brush?

It was a hectic shift so far in the ER and I felt like nothing more could come in to surprise me that day. I was wrong.

I looked up to see a male patient about 35 years old being rolled in and he was in a great deal of discomfort. He was perspiring and the look on his face was one of a person in agony. He was athletic looking, in great shape with a full head of brown hair. His tan was perfect and his teeth were perfect, he looked like a model to me. 

When I checked his chart it was pretty vague, only showing his chief complaint as abdominal pain. I thought maybe he had gall stones or something. 

Then my eyes were turned to a patient who walked in that was dripping blood as she walked. She had black hair with about 3 inches of white roots that had grown out. She had anger or pain or both that had caused her to be wearing an ugly scowl as she walked through the doors. She had nearly severed her thumb with a kitchen knife. With every step she was cursing her husband for sharpening her knives without telling her. As she passed me she said “Damn it Joe, you could have warned me!” Her husband followed with his head dropped low and his shoulders slumped in shame as he mumbled something.

After the excitement of the angry, cursing wife, I turned my thoughts back to the good looking muscular guy who came in a few minutes before with abdominal pain.

I looked at his chart on the computer and then talked to the triage nurse who had assessed him. She said according to him and his wife, he had come in drunk, very drunk at around 4:00am and he had red lipstick on his shirt, it was a color his wife would NEVER wear. He also smelled of someone else’s perfume. His wife added that this was not the first time. .

When he stripped off and went to bed (she explained he always sleeps in the nude), she began plotting her revenge. He was incoherent and was speaking another woman’s name in his drunken stupor as he slept. She thought about what he had done and she thought about what she would do to him. The decision for revenge was to shove a hair brush into his rectum. She tied his arms and legs to the bedposts as he slept heavily from all of the alcohol he had consumed. She looked through her brushes and found one that had bristles all the way around, it was perfect.

When the xrays proved it was true he had a brush in his rectum and would need to go to the operating room to have it removed, she seemed pleased. She stood smiling and proud of her handiwork, he looked miserable and truly sorry for what he had done. It seemed that a brush can totally sober a person up when used in that manner.

On that shift I had seen two angry wives. One injured herself and was furious at her husband as she blamed him. The other injured the husband and was furious at her husband as she blamed him. Angry wives are probably not creatures you want to cross.

Up and Ready to Go

He was up and ready to go!

In the years since a certain prescription medicine became available so many things have changed in our society and in the medical field, and it has increased ER visits. 

I worked in two different ERs over the years and I saw the cases I am about to discuss at both, plus I talked to many of my medical worker friends, both nurses and doctors who spoke of cases they had seen as well.

The first patient I saw who came in with this problem was a middle aged man. He had rough scaly skin and unruly looking hair, plus the grimace on his face was one of intense discomfort. He was in some real pain and it was very obvious that he had an erection. His problem was caused by Viagra. He said; "At first it was fantastic!" He added, "But  the erection would not go down!"  "Long after the pleasure was over, she was zonked out and I was miserable as the time ticked on the pain built up. I was NOT going to the ER with this problem. I waited and waited until almost 6 hours had passed and there was no relief."

He had Priapism, which we have seen a lot in the ER. It is very uncomfortable and if not treated it can be very serious, even causing permanent issues. 

The  possiblity of getting Priapism is explained on all of the Viagra and Cialis commercials that you see on TV, “If you have an erection that last longer than 4 hours, go to the nearest ER.”  If you watch TV at all I am sure you have seen these warnings.

Believe me this does happen and it happens more often than you might think. Some men are so miserable by the time they decide they must go to the ER to get relief, it has reached a serious point.

It is really not funny, but I have to admit we have had late night discussions at work about the things that are funny associated with these patients. First of all we know immediately what brought them here as soon as we see them standing out in the ER waiting room. It is quite obvious and often they are actually holding their hands on this poor aching appendage.

There are procedures in place to correct the problem but if it goes over 8 hours without correction, some permanent damage is likely, including impotence.

Besides priapism, there are other issues caused by Viagra and Cialis that now appear on a regular basis in most ERs. This other problem includes heart attacks or heart palpitations or light- headedness to the point of passing out. We see younger and younger men who are coming in with their hearts racing or sometimes heart attacks due to the effects of this drug.

For some reason men do not want to admit to the doctor upfront that they took a pill to fix erectile dysfunction. I understand that because, female employees in the ER are right there and they are embarrassed. My advice is when it comes to severe pain and misery, throw that embarrassment out the window and talk straight to the ER staff. 

Unfortunately, when asked about that along with all of the other questions, they choose to deny it. It is extremely important to swallow your pride and be honest anytime you come to the ER. You are the one who takes all the risks, if  you hide things from the medical people who are trying to help.

There are an alarming number of men who already have pre-existing problems like high blood pressure, yet they ignore the warning on their viagra bottle, “if you are on certain blood pressure medicines, DO NOT USE this product” 

Some of them have told us they decided to create a work around by stopping their blood pressure medicine for a day or two and thereby making it ok (in their minds) to take the Viagra. In other words it was worth risking their lives to correct their erectile dysfunction for an evening.

I have had them call me to their bedside, as they look up at me in a panic, they will ask me to please go back and tell the physician that they lied and did in fact take the Viagra.

Men are funny creatures, I know women are unpredictable and strange too. But when it comes to sex, men are predictable. If they find out there is a drug that makes their man parts perform better and longer, they are going to walk, run, drive, push, pull or crawl to get it. Side effects, even serious ones, do not deter them.

I once heard a bit by Jay Leon shortly after Viagra went on the market. He said, “A guy can read on the side of that bottle, your head will ignite and go up in flames, yet that means nothing to them, as long as it says it will fix erectile dysfunction and increase the length of time of an erection, they don’t care at all about any side effects!” They are standing there like a kid recieving a long awaited toy as you are explaining how to safely play with the toy, they are jumping up and down saying, "Ok, Ok, Ok just give it to me!"

I realize this is a widely used product and probably pretty safe, but it is important as with any new toy, that you follow the instructions and play safe...You don't want your head to ignite and go up in flames do you?