Board Thread:Writer's Workshop/@comment-35711173-20180613055407

I was thinking of posting this in categories Mental Illness and Hospitals. The image below is from Wikimedia.

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In my emergency medicine residency at St. Mary’s Hospital, I had grown used to ambulance sirens, gunshot wounds, broken bones, drug overdoses and the smell of grinding poverty. It was all in a day’s work. There was a reason why emergency medicine doctors made the money they did.

Already this morning a patient hit me in the face with her purse after I denied her a prescription for oxycodone and we had a screamer threatening the admissions clerks. With some anxiety, I read the notes from the city jail on my patient in room 3 and breathed a sigh of relief that he was only in for shoplifting and was suffering from high blood pressure. He was an elderly black male who had been brought by ambulance. The patient wore blood-stained clothes. Both his eyes were blackened. I pointed to his eyes and the blood on his shirt. “What happened?”

He nodded to the uniformed officer standing directly outside the treatment room. “Police beat me up when they arrested me. But I didn’t do nothing.”

“Your notes say high blood pressure. Have you suffered from high blood pressure before?”

“Oh yeah. For years. But the jail took my pills away from me.”

A nurse took his blood pressure. It was 261 over 136. That blood pressure wasn’t just high. He was going to stroke out.

As soon as I gave orders for IV emergency treatment for hypertension, the overhead pager echoed throughout the department. "CODE TRAUMA NOW." “CODE TRAUMA NOW.” I went to the trauma room, donning a gown, gloves, and mask. I had expected paramedics with a stretcher, but two orderlies were pushing a gurney. My eyes widened when I saw the patient. His name was Billy Wong. He was a second-year Pediatrics resident, and he was one of my friends.

One of the nurses in the room begins to document all trauma findings on the trauma flow sheet that I dictated as I examined Billy. To save his life, I had to see him for the moment as just another patient and not the person who I carpooled to the hospital as we hooked me into playing for the St. Mary’s Knights soccer club. “Patient is a male Asian American, 29 years old. The patient is unconscious and presented as unconscious.” I turned to the orderlies who brought him in. “What happened?”

“I went to hit the head in Pediatrics and found him passed out on the floor like he slipped and fell.”

“How long had he been down?”

The orderly shrugged. “Maybe fifteen minutes. I had just seen him with a patient.”

“Did he regain consciousness at any time.”

The orderly shook his head. “Nothing. Not a peep.”

“You got that,” I asked the nurse and she nodded.

“Patient blood pressure is 171 over 100. His pulse is 50 and respiration seems irregular. The patient is bleeding from a small wound on the left side of the back of his head. The wound appears to be depressed into his skull by about a centimeter. There is vomit on his lab coat.” I checked his eyes. “Patient’s right pupil is dilated and non-responsive. Clear fluid is leaking out of patient’s nose and ears. Symptoms indicate the injury has caused a severe traumatic concussion to the head. I am cleaning the wound and applying a bandage. The rest is for the neuro team.” I turned to the nurse. “CT scan of his head. Stat.”

I never had any clue what would walk in during my shift in Emergency. Having a friend on the table with a life-threatening injury something I had never even considered. Even stat I knew it would be at least an hour before the CT scan of his head was completed and read. I notified the neurosurgery group to get a team together and prepared. With that skull depression, Billy was going to need it.

Residents are taught to “suck it up.” I kept thinking of his wife. She was eight months pregnant. She could be a widow by the time the shift was over. I saw my wife and my children. This time I couldn’t just turn my feelings off like a machine. I tossed my gloves, gown, and mask in the trash. “I will be right back.”

I went out the back doors of the emergency department and said a silent prayer as I walked around the halls. I kept visualizing the location of the injury. What part of the brain would be injured? Would it be the temporal lobe or auditory cortex? If he were lucky, just his hearing in his right ear would be impaired. If not, he would lose ability in language and memory. That would make it difficult to be a doctor.

I suddenly and utterly desperately had to pee. Ever since I was a small boy, high stress manifested in contracted bladder muscles. Now it felt like it was bursting.

I knew the closest bathroom was by radiology. I was within sight of my goal when a Hispanic woman carrying a little girl stopped me. “Where is the emergency room? She is burning up with fever.” With that, the little girl puked a good six feet and nailed my pants leg. I sighed.

“It’s back and around to the left and then a right and …”

Dr. Wilhelmsen stared right at my face as he neatly steered around the puke on the ground and ducked into that bathroom I so desperately needed to use.

“I’ll take you to admission.” I was sure that I wouldn’t make it to the head in time but wetting my big boy pants would be better than being chewed out by Dr. Wilhelmsen and the rest of the senior staff.

As I began to lead the mother and child, I heard "It's fun, it's fun, it's fun" echoing from the bathroom. A young black man in disheveled clothes and a wild beard burst out of the men's room and looked at me with pure fury. He lurched towards me. Then I saw the hammer in his hand and the blood dripping off the hammer's head.

For a moment I froze, but something deep inside me said: "RUN!" I ran as fast as I could, knees trembling. I tried to shout "CODE SILVER," but my throat was too tight. I slipped my badge over the card reader, burst through the double doors into the ER and pushed them shut. I finally managed to stammer "There's a Code Silver by the bathroom near radiology, looks like a bum, male negro, blood dripping from a hammer" to a security guard. My pulse was racing. My hands were wet with sweat. I could feel that I had wet my pants but I no longer cared. The guard went through the doors. The cop who was watching the prisoner with high blood pressure drew his gun and followed.

I swallowed my fears and showered. The hot water and then changing into my spare scrubs calmed me. Then it was time to go and suck it in and pretend to be a doctor. I was instantly slammed with yet another narcotics overdose. As I was spraying narcsan up the young man’s nose, two middle-aged men with shoulder holsters printing through the jackets of cheap suits knocked on the door of the treatment room and waved badges at me. “Oh great,” I thought. The patient in room three walked out the door during the confusion.

I had the nurse take over and went out to face the music. One of the cops turned to me. “Are you Doctor Patrick Murphy?”

I nodded. “Yes.”

“This is lieutenant Romero. I'm lieutenant McCarthy. We're from homicide division.”

My eyes widened. “Homicide?”

“Yes. We understand you were near the bathroom where Dr. Wilhelmsen’s body was found.”

My mind raced. I felt dizzy. The bathroom I almost went in. 