mark-plasterThe two women sat quietly in a corner of the busy ED, almost lost in the business of people being shuffled off to get labs and x-rays. The elderly woman sat with her head bowed in prayer or pain while the younger woman looked anxiously at her. Even though the chief complaint was “chest pain” she had been brought in her daughter’s private vehicle instead of an ambulance. 

mark-plasterI picked up the first chart of the night and read the chief complaint. “Suicidal.” You never know what that means. It could be an old man who has sat all day with his shotgun in his mouth and finally thought better of the situation. It could be a belligerent drunk who was thrown out of his house by his wife and knows that he can stay in the hospital over night if he claims he is going to kill himself.

mark-plasterOne of the things I like the most about the ER is that it is the real “No Spin Zone”.  More accurately, it’s the “No BS Zone”. The dynamics are straight forward. It’s just me and the patient. He’s sick and I’m there to help. It doesn’t matter if he smells like moldy gym socks or if he’s completely broke. It doesn’t matter if he likes me, and it certainly doesn’t matter if I like him.

mark-plasterThere were no patients to be seen when I walked down the hallway to get a cup of coffee. But when I returned to the nurses’ station, Heather, one of the regular night nurses, was holding a chart and looking at me, quizzically. “You have to see this guy,” she said. “I don’t have a clue what’s going on.”

mark-plasterSometimes you end up working a holiday because you are too lazy to check the calendar. Believe it or not that’s just how I ended up working on my last birthday. Thank goodness it wasn’t my wife’s birthday. But when I entered the ER last night and saw all the hearts hanging on the walls, I realized I’d blown it again.

mark-plasterIt was my turn to work New Year’s Eve and I was hoping against hope that bad weather, the down economy and fate in general would combine to make it a slow night. I would have settled for even a slow start to the night. But it was not to be. The jammed parking lot was my first clue and it was cause for a deep preparatory sigh and an additional squirt of stomach acid as I trudged through the ambulance doors.

mark-plaster“Hmmm,” I said, half snorting, half sighing as I scanned my email in-box. “It looks like now every insurance policy is going to have to cover psych admissions.”

I’m proud of the fact that I’m self sufficient in the emergency department. And it irritates the fire out of me to see prima donnas (read surgeons) come into the department and require the entire staff to follow them around to do little things they could do for themselves. I guess you could say that I was trained well by a charge nurse by the name of Beatrix where I did my residency.

Something had just happened that I didn’t understand. A man had stared death in the face and winked. But more than that, the life he had exuded, even in the moment of dying, seemed to still  be present. His son was different. I was different. More alive. More human.

I love it when the lecturers say the same thing: “Take a good history…” They act as if we don’t know what questions to ask. Don’t they get it? The right questions are written on the template. But sometimes I just didn’t know what to do with what the patient told me. Let me give you an example

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