No Thanks

the emergency roomSometimes, in the emergency room, we have to put patients in physical restraints- for their safety as well as ours.

A patient comes in for a mental health evaluation- the dude is huge. Luckily (for us) he’s got his equally large brother with him to keep things controlled. The patient was in restraints on his trip in the ambulance, so we decide it’s best that we place him straight into restraints when he’s transferred to our gurney.

I’d just completed some training on restraining patients in a safe and professional manner so I took charge and let the rest of the staff know that I would be at the patients head- and would be the only one talking to him while we applied the restraints. Staff tells me that I can go ahead and do that but he’s not gonna respond to what I tell him- he’s been mute since EMS was called.

The point of talking to the patient isn’t really to make conversation, it’s to be professional and keep the patient informed to alleviate some of the stress of the situation. So we go ahead as planned. Limbs are assigned for restraint and I take my place at the head and start talking to our patient.

“Ok sir, we’re placing your left arm in restraints now, we’re doing this for your safety,” and so on. I tell him, “I’m sorry we have to do this, it’s for your safety.”

Out of nowhere, the guy looks up at me “I forgive you,” he says.

“Uhhh…thanks man.”

“You are forgiven.”

I don’t really know how to respond but it’s nice that he’s broken his silence and the things he’s saying are not threatening- so I continue and reply again, “thanks man.”

“I love you…”

Uhhh…I guess that’s a nice thing to say. It’s certainly not a threat which is the only thing I’ve been worried about with this guy- up until this point. I respond again with “thanks man.”

Next thing I know, this guy has his lips pursed and he’s started to sit up and his mouth is making a beeline- straight for my lips.

“No!” is all I can manage to say- as I push this guy back down onto the gurney, one hand on his forehead and the other on his upper chest. The problem is, he’s really strong so I have to really exert some effort in pinning him down- and I’m squeezing his forehead pretty tight.

It takes me a few seconds to compose myself and then I manage to say “I hope I’m not hurting you.” He replies, “you’re not.”

Wow, I was glad when that was all over, I tell the doc- “that dude tried to kiss me!” We had a good laugh about it and got back to work. Such is life in the emergency room. I wish I could say that was the only time that something like that happened…

Tased and Confused

Here Comes the Pain

Ever been tased? Yeah, me either…except for a few times as a teenager with friends….with tasers from the corner store. Never have I experienced the shock that comes from two electrically charged barbs stabbing into me and lighting me up like the first smoke of a discharged patient. The feeling that causes grown men to fall down, curl up into the fetal position and sometimes wet themselves is foreign to me- and I’d like to keep it that way.

We often get patients brought in via police chauffeur that have been tased. If the barbs end up sticking in a tricky place, the patient may show up with jewelry in place- to have them removed by a doctor. I’ve never been in law enforcement but it seems that most times someone has been tased, they deserved it. Still…some of these tasings seem like they are just down right awful…hopefully enough to get the recieving party to think about changing their ways.

There’s no way for the user to control where the two magical taser barbs end up, and when you’re doing push-ups in the hallway- trying to pump yourself up for police confrontation…you’re just asking for it.

I always thought push-ups were a great source of exercise and could offer great health benefits. Even though I’m on a program to get to 1000 pushups a day (I’m at 500 right now,) if an officer of the law is drawing down on me with a taser, I won’t try to scare him off with a round of pushups. Oh no…he can lift his own body weight repetitively…we better just leave…

Ever licked a nine volt battery? Try licking 900 nine volts-at once. That’s what it’s like when one of the taser barbs ends up stuck in your tongue as you try to spring up from your last super-set of pushups. Getting your tongue pierced looks painful enough, but sticking my wet, freshly pierced tongue on an electric fence…no thanks.

As it turns out, it’s hard to make your raps sound cool with a taser barb and half a foot of wire hanging out of your mouth.

Fire Crotch

Of my tales from the emergency room, this one will definitely be re-posted to the top stories page…

I come on shift to find that I’m going to be doing a 1:1, this involves watching over a restrained patient(s) and documenting their behavior (baby sitting.) The patient I’m watching was brought in by the police department after quite a fight. Needless to say, he went from their handcuffs- straight to our restraints.

This gentleman (a definite stretch of the word) goes back and forth from being friendly with me, to downright threatening my life. He’s big and he’s mean and he makes sure that I know it. I spend mass time and energy trying to convince him to come to ct scan with me and finally he agrees. I take a security guard with me and he cooperates to go from the ct table- back to the gurney and into restraints.

Not long after I get him back to the room, he informs me that he has to pee. Luckily, he has enough slack on the restraints to perform the necessary movements on his own, so i just have to give him a urinal that’s sitting on the counter. He’s unable to make any urine, “stage fright,” he says…I hadn’t pegged him for the timid type.

Fast forward a couple minutes, he says “Dude, what was on that urinal… my dick hurts.” I tell him that the urinal was clean and assume he’s delusional. “Dude, can you get the doctor to come look at it? I think there was something on that urinal!” I reply “No, there wasn’t anything on the urinal and if you got something from a urinal, there wouldn’t be any visible symptoms this fast. “Well, can you look at it?” he says…

Now, I’m not in the business of examining people’s private parts nor do I have the expertise to diagnose any findings- so I tell him no. He’s getting more and more vocal and he’s really rubbing his crotch at this point. He rubs and rubs and gets louder and louder, “dude, my dick hurts, it HURTS!” At this point I have no idea what’s going on but this dude is getting pretty worked up.

All of a sudden he stops and looks up at me. “Noooo! The pepper spray!!!” he exclaims.

The police had hosed this guy with so much pepper spray, you would’ve thought they were cross-training with the fire department! Every time I went over by the guy, to give him some juice, my eyes would start watering… his face had been soaked in mace.

It’s only natural to rub your eyes when they’re on fire, and while using the urinal, he had transferred a bit of the residue to his groin. The best part was, that before he figured out what was happening, he was rubbing his crotch like a madman trying to sooth his pain- oops.

For the next half hour, he wailed and moaned, dropping F-bombs at full volume and writhing around in agony. I put some gloves on him and fed him a steady supply of wet wash cloths until the pain finally subsided. The rest of the day went much better, it was just what was needed to break him of his attitude. Hilarious.

And…Breathe

You might think from the title- that this post is about a patient with respiratory issues…it’s not. You know when you have one of those days at work when the demand is high and your energy supply just seems inadequate? Today was one of those days.

It wasn’t bad to start but the emergency room is one of those places where one “customer” can require an incredible amount of time and energy. Run to ct scan, form a splint, down to mri, check in an ambulance…the list goes on. It can become difficult to stay in a caring and focused mindset when you’re brain is going through the checklist of what you’ve accomplished and what you still have to get done.

Then the patient that makes it all come crashing down. Someone that cares less about there immediate well-being than they do about having a cigarette.

In this particular case, the patient is suffering from a severe injury. The injury is so bad, the trauma surgeon says that it’s the worst of it’s kind that he’s witnessed in 20 years on the job.  What does this patient do during their stay? They curse and complain, yell and threaten…partially in pain…mostly- because they want a cigarette.

The nicotine drama is nothing new in the ER. Quite frequently, being denied the opportunity to inhale the sweet carcinogenic cloud that tobacco provides, our patients can become agitated beyond reason and often end up leaving against medical advice.  Every once in a while, someone is such a handful, and our desire to treat their condition is so great, that we’ll break policy and allow the patient out to smoke.

Back to our problem child- gravely injured and yet most concerned about their cigarette break…a doctor gives the go ahead to take the patient outside in a wheelchair to smoke. I get the joy of accompanying said individual out to inhale un-fresh air. This is where it really gets interesting.

As we approach the door to the ambulance bay, I notice this person doesn’t have a cigarette- ready and prepared to go. So my question is: “did you bring your cigarettes with you?” The response I get: “Nope, but I’m sure as hell gonna bum one!”

Unbelievable, that after all this drama, this person didn’t even have a cigarette to smoke. There’s no way I’m gonna let this patient approach someone on the sidewalk, even though a potential victim has already been spotted at the bus stop. I can’t believe I’m gonna do this, but I walk over and ask hippy #1 at the bus stop for a cigarette- he’s happy to oblige me.  Am I done humiliating myself yet?…Nope! My gravely injured and furiously addicted friend informs me that they are without a tool to make fire…wow. Now I have to go back to the bus hippy and ask if he’ll light the cigarette for me. The look on his face was priceless- He says “you want me to light it for you?” like I’m some kind of pervert. Nevertheless, he hooks me up and I carry the torch of hope back to my friend.

When the smoke clears, and the patient is back in bed, it can take a while to de-compress from the stress of an incident. This particular case wasn’t too bad but it’s always good to remember why we are in medicine. For me, I’m there to serve, and if that means bumming a cigarette (and a light) to ensure that a patient stays to recieve the care that they really need….I’ll do it. It’s all about perspective…