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. I could hear that we had a screamer threatening the admissions clerks as I was charting on my iPad into MEDHOST a drunk and disorderly from the city jail who had presented with the incredibly high blood pressure of 261 over 136. 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 he conned 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 circular wound on the left side of the back of his head, looks maybe 25 millimeters in diameter.” I wondered what in the bathroom could cause such a perfectly clean one inch in diameter injury and couldn’t picture anything. “The wound appears to be very evenly depressed into his skull by about a centimeter.” 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. 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 with their first. 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 went to the chapel. There I lit a candle and said a silent prayer. 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. “Please doctor. Help me. She is burning up with fever.” With that, the little girl puked a good six feet and nailed my pants leg. I sighed.
“The emergency department is back and around to the left and then a right and …”
Dr. Wilhelmsen stared right at my face and grinned 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 emergency 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 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 that perfectly circular one inch in diameter hammer's head, just the size of the wound on Billy’s head.
For a moment I froze, but something deep inside me said: "RUN!" The woman ran in one direction, back the way she came and presumably to another hospital. I ran in the other, knees trembling, hearing him stumbling after me. I tried to shout "CODE SILVER," for a non-patient with weapons in the workplace but my throat was too tight. I could hear him running behind me. I slipped my badge over the card reader, burst through the double doors into the ER and pushed them shut. He hammered frantically on the double doors, determined to beat them down. What if he got through?
I finally managed to stammer "Code Silver. He attacked Dr. Billy Wong. Looks like a bum, male, blood dripping from a hammer." My pulse was racing. I could feel that I had wet my pants but I no longer cared. Two guards went around to the ambulance entrance to cut him off. The cop who was watching the prisoner with high blood pressure drew his gun and followed.
Another guard came up to me, calling the code silver into his walkie-talkie. The overhead pagers boomed to announce the emergency. “Did you see a gun?”
I shook my head. “Hammer.”
“Tell me what happened.”
I tried hard to think and to put it in words. “I was going from the chapel to the bathroom by radiology. A woman with a sick child couldn't find the ED. I was leading her. Dr. Wilhelmsen went into the bathroom, and this man came out with a hammer dripping blood. He chased me back here.”
The hammering stopped. Now I heard shouting and arguing. The Active Shooter Response Plan training last month had said that staff members shouldn’t attempt to intervene or negotiate. That suited me fine. Let the paid professionals handle this one.
I hit the ED’s shower. 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 pulled 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. I had the nurse take over. 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.
Written by DrBobSmith