The night was bitter cold but so windless that if you stood still only your nose and finger tips felt it. The dry snow crunched and squealed as the ambulance drivers turned their wheels to back onto the bay to drop off the two patients inside. It was Christmas Eve and the only people working that night were those who got the short straw. But they were trying to make the best of it.
Have you ever asked a patient a question only to have them mumble into the blanket or to the wall so softly that you couldn’t understand a word they said? Or worse, I’ve had patients, for whatever reason – anger at the wait, a show of control – refuse to answer my questions or say anything at all. “I don’t care if you only have a few minutes with me,” they seem to say. “Don’t bother me, I’m napping.”
It had been a quiet, peaceful summer afternoon and I wasn’t really looking forward to the chaos that I knew was waiting for me in the ED. Two ambulances were empty with their doors still standing ajar and two more were parked in the parking lot when I arrived. I stopped for one last moment to look out over the harbor before entering the ambulance doors. I took a deep breath and plunged into the department like a fresh substitute in a football game.
The 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.
I 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.
One 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.
There 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.”
Sometimes 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.
It 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.
“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.”