As I arrived to work I saw that the parking lot and the waiting room were packed. This is not supposed to happen at this place.
“I’m getting too old for this,” I mumbled to myself as I dropped my 2am lunch in the frig and grabbed a handful of charts. I’d raced through an hour of charts before it dawned on me that they were filling the rack as fast as I could empty it. I finally looked at the log-in time and saw that the “door-to-doctor time” was approaching three hours. I felt terrible, but there wasn’t much I could do except work as efficiently as possible.
“I am so, so sorry that you have been waiting so long,” I said to my next patient, an older African American woman.
“That’s OK, sweetheart. I can see you’re busy.” I love this place, I thought. Most of my career I’ve worked in either high crime, drug infested urban ERs or wealthy white collar suburban departments. Both seem to breed obnoxious, demanding patients. This ED was different. Suburban, but clearly blue collar, these patients had never had the coke spoon or the silver spoon. And I loved taking care of them.
“Thank you,” I said honestly. “Now what can I do to help you.” I focused intently on her and her alone for the brief minutes I had to spare.
The rest of the early evening seemed to fly. Even though I was working rapidly, the patients were patient. And I was just getting the glimpse of the light at the end of the tunnel. And that was OK with me. It seemed we were all working for the same goal.
Then a young man stepped up to the desk. “How long is it going to be before someone gets their ass back to see me?” Now this was the kind of patient I was accustomed to seeing. “I’ve been waiting here so long that my cell phone battery has died!”
I don’t know why it struck me as funny. I guess it seemed like he was saying he’d been there so long he’d grown a beard or something. Suddenly I could see them turning on the six-hour version of Pride and Prejudice in the waiting room. Anyway, I chuckled.
“I don’t think it’s funny,” he said, glaring at me. “Look at my arm. It’s deformed. What’s going on here?”
I looked over the huge stack of charts to see his bulging bicep. It was clearly misshapen.
“Are you a boxer or a weight lifter?” I said tentatively, glad that there was a barrier between this angry man and myself.
“Yeah, I lift weights. And my arm suddenly got like this. I have a body building contest next week. So I need to have it fixed.” Then he resumed “the look.”
Now I could see that he was too pretty to be a boxer. He preferred prancing around on stage flexing his muscles while wearing a thong. “Oh, that looks like you blew out one of the heads of your biceps. There’s probably not much we can do for you here tonight,” I blurted out without thinking. I looked through the charts in my arms hoping I could dispo him quickly.
But all of them had complaints with higher priority. I couldn’t justify making them wait longer. But I reassured him that either I or the PA would get to him shortly. I started to charge off to the next room.
“Aren’t you going to do something?” he demanded, stepping into my path. “Can’t you see that there is something wrong with my arm?” He squinted his eyes and flexed his good arm trying to look mean, but I just couldn’t get the funny picture of this guy in a thong out of my head. His intimidation act just wasn’t working. In fact, it was a bit comical. Nevertheless, I was concerned that he was gumming up a perfectly efficient night. Now I was going to have to take a half an hour and try to explain to this muscle brained moron that you can’t lift a 400 pound weight with 200 pound arm strength.
“I’ll take care of him,” said Anne, the PA who as assisting me, as she looked through the rack for his chart.
“I owe you,” I whispered as she passed. She smiled wanly knowing that she was taking one for the team. I raced off to a room as she led pretty boy back to his room.
Later, as I passed the nurses’ station I saw the patient leaving with a sling. “I waited here five hours to have ”her” give me a sling and send me to an orthopedic surgeon,” he shot at me, attempting to give me his best pouty look. I shouldn’t have responded.
“Hey, I’m really sorry. It is what it is. I’m not so sure the orthopedic surgeon will do much for it either.” I realized that I had stuck my foot in my mouth again.
“Really?” he said incredulously. “You mean I’m going to be like this forever?” Then I realized that I was going to have to do a half hour education of this patient after all. By the time I finished, the rack was full again. And now I was exhausted.
The night finally ended and I raced home to finish up my writing assignments. “Can you get me some coffee,” I said to my wife as soon as I entered the door. “I’ve got some work to do before going to bed.” I trudged off to my office.
“I’ll get you the coffee, but first you have to ask me nicely,” she said with a defiant look.
“Oh darling,” I said with syrupy sweetness. “Will you be so kind as to make your poor tired hubby a little tinsy cup of coffee? I made my best begging look.
“Keep it up and you’ll be wearing your coffee,” she warned. “And more importantly, we have some bad news.”
Really? I mumbled. “What’s wrong now?”
“Julliet got sent to the ‘thinking chair’ three times yesterday for giving Yolanda ‘the look.’ She warned her that if she keeps it up she’s going to get sent to the principal’s office.”
Julliet is our granddaughter who had just started kindergarten. Yolanda is a family friend who just happens to be her teacher.
“The Look” is Julliet’s attempt to be defiant, angry, and pouty.
“She’s only been in school a few weeks and she’s already giving Yolanda ‘the look.’ Anyway, I think it’s funny.”
“You won’t think it’s so funny when she’s a teenager. She looks like her head is going to spin around like on some horror movie. If she gets sent down to Mike’s office, he’s going to paddle her cute little bottom.” She paused a moment. “Well, not really all that hard, but she’d get the idea.”
“But what’s the ‘thinking chair,‘ Is that just this new schools name for “time out”?
“I guess it is, sort of. But Yolanda really tries to do more than just punish her. She tries to get her to think about what is going on in her heart and mind when she looks like that.”
“Hmm,” I thought back over the night, recalling my pouty weight lifter. I realized I hadn’t really taken his concern seriously because it wasn’t something that I was going to ‘fix’.
“What” my wife asked, seeing my distant gaze.
“Oh,” I said after a moment’s reflection. “I suspect that we could all stand a little more time in ‘the thinking chair’.”
Dr. Mark Plaster is the founder and executive editor of Emergency Physicians Monthly