25 July 1996




I'm off today.  Worked until 07.00 yesterday morning, so the day was basically a wash.  It's a lot more benign that it would be if I were taking call for something like surgery, but hell, I'll get my sleep when I can.  Anyhow, the phone rang this morning, early-ish.

"Did I wake you up?"

"Yeah, but don't worry about it.  I need to get cracking on odds & ends anyhow."  --Just a friend calling to see what's up, how things are going.

A while later I'm in the shower, having decided that this would be a good time to clean the entire bathroom.  Simple mindless work, and thus perfect for my frame of mind.  Still, I can't shake this feeling that there's something I'm really supposed to be doing.  Stare at my watch, trying to think.

Oh yeah: Thursday morning emergency medicine conference.  I am screwed.  I forgot to set my alarm last night when I came back from dinner with my folks up at Royal's.  Damn.  The conferences are good you see, and what's more, attendance is required.  Ah well - it's too late now; and besides I will most certainly be hearing about it from one of the chiefs. 


So I'm running through cases from the last week or so, trying to see what sticks out in my mind.  There's the two parents who I kept wanting to hug or present with a medal or plaque or some such - Their car was hit from behind out on the Parkway; just one in a seven car pile-up.  Two of their kids are running around the room, playing with an inflated surgical glove, while the seven month old infant coos up at me from dad's arms. 

"How fast was the car that hit you going?"

"I'm not really sure."

"Ah - okay, how badly was your car messed up?  I mean, how far in was the rear bumper squooshed?"

"Oh."  Dad scratches his shaved head with a thickly tattooed arm.  "About thirty inches, I'd say."

I look back at him, astonished.  "Thirty inches?"

"Yeah, the bumper was pretty much crunched up to the rear window."  He stops for a moment, thinking again, "and the front end was crunched in about a foot from hitting the car in front of us.

I stare at the kids, then at mom and dad.  Dad has a band-aid on the side of his head.

"I suppose you guys were wearing seatbelts and had the kids, including the baby, in car seats."

Mom looks back at me earnestly.  "Oh yes.  We're very careful about that."  She has a great smile. 

So I examine the kids, each in turn.  They're fine.  Happy laughing kiddos with concerned heavy-metal parents.  The only thing any of the family has to show for it besides addled nerves and a trashed car are a few minor first degree burns courtesy of splashes from an open cup of coffee.  As I go through the exams, I'm thinking about how it could have been - the infant would almost certainly be dead; crushed as mom's torso folded over on top of him, or from bleeding into his brain after bouncing off the windscreen.  The others would be up front in our trauma rooms.  It's a gruesome line of thought, and I force myself to leave it alone.

I say to the parents, "Thank you.  I mean it."

They look at me, at their kids, confused.

"I think you probably saved at least one of their lives," I say, indicating the children.  "You definitely prevented some very serious, possibly crippling injuries.  Thank you.  Your kids would thank you too, if they could appreciate what you spared them today.  Keep an eye on that burn there, but it doesn't seem to be bothering him much, so I think it will be fine."

Mom beams at me.  Dad looks kind of embarrassed but delighted.  I send them home.


Then there was the child who was there to be evaluated for sexual assault.  Apparently there was also a custody issue between different sets of caregivers.  I went into the room feeling slightly apprehensive and more than a little skeptical - it's not unheard of for caregivers to coach children in order to gain custody, and this was a very messy custody dispute indeed.

"Alright," after some banter between the purportedly assaulted child his sibling about who the doctor was supposed to examine first, "Can you tell me what was happening that makes you feel afraid to go back to that house?"

"It's okay," from one of the caregivers.  "He's the doctor.  You can tell him."

The boy looks at his shoes, the wall, everywhere but someone's face.  He shifts about nervously.  "He put his thingy in my bum."

I listen to this child's tale in growing horror.  It's a good story.  It spanns several months, and it's consistent.  Kids that age simply do not tell graphic stories about sex unless they've experienced it, nor do they manage to keep long complex lies internally consistent.  I believe the boy, every word. 

He doesn't start to cry until I tell him I need to do some blood tests.  Then he whimpes non-stop until the nurse sticks him.

"Oh.  That doesn't hurt at all," he announces scornfully.  "I thought it was going to hurt like --" he drifts off into silence.


There was also the gentleman with - well, I never really found out.  The registration sheet says, "abdominal pain," the triage sheet says, "back and leg pain," and when I ask what brought him into the emergency department that night he tells me, "I think I have sugar."

I dutifully catalogue his list of complaints, interposing questions so I can rule out truly emergent pathology.  After giving him a thorough physical exam, I tell him I'll be back shortly, and go out to present to my attending. 

"Wait - say that again.  What are his headaches like?"

"Well, he says they start in the morning, like someone's drilling through his forehead with a hot spiky drill bit.  Later on, it moves around to different parts of his head, following the sun."

"Does it keep him up at night?"

"No, it seems to go away as the sun goes down."

"Ah yes," one of the other attendings chimed in, rubbing his chin seriously.  "The heliotropic headache.  Very interesting."

After I regain my composure, I stick his finger to check his blood sugar and then reassure him that he does not have diabetes.  Then I tell him that though I really don't know what is going on, I don't think there is anything of an emergent nature happening.  When I suggest that he follow up with an internist, he thanks me earnestly.  I give him an appointment with our internal medicine clinic and send him home.

My writing on the chart is nearly illegible because I can't stop giggling.  Heliotropic headache.  I love it.



One of the patients I saw in the early hours of yesterday morning was rather a change of pace.  Not so much for what was going on with her, but for what was going on with her friend.  The lady in question was afraid her allergies had flared up, and that she couldn't breathe.  In the exam room she was comfortable and conversational, and her lungs were completely clear. 

When I told her that I couldn't find anything worrisome in her physical exam, she offered, "You mean I just got myself all excited and hyperventilated?"

"Well, I don't really know what happened, but I think you're doing pretty well now.  What do you think?"

"Actually, I feel fine.  Oh my, I'm so embarrassed."

"Well, better safe than sorry eh?"

Her friend spoke up.  "Doctor Marcus, how many young ladies are there waiting for you in the parking lot when you get off work?"

"Ah - none," I said, startled.  I had introduced myself with my full name, and they seemed to prefer my first.  Whatever works for 'em, I guess.

"Oh, come on - I can't believe that.  Really - how many women are waiting to get their hands on you?"

"None that I know of," I said smiling nervously.  "I should be so lucky," I continued in a misguided attempt at humor.

I excused myself gently to present to the attending.  As I sat down to write up her chart, he went in to say hello to her and assure himself that I hadn't missed anything.  He was just leaving her room as I went back in to discharge her, and he shot me an evil grin as we passed.

"What?" I asked.

He shook his head, smiling, and kept going.

She asked me a couple of questions as I went through her discharge instructions (return if you can't breathe, if you start coughing uncontrollably, if your tongue or face swell up, et cetera) and then her friend interrupted.

"Are you done now?  You just put your shirt on while I ask the doctor a couple of questions."

"Oh no," I thought.  I turned to look at her, and asked, "Yes?"

"Doctor Marcus," she started, smiling, "Do you have breakfast when you finish in the morning?"

"Umm - no."

"Well, you know - I cook a mean breakfast.  How would you like to come over and have some breakfast?"

"Oh gosh," I replied, (yes, I actually said 'gosh') "I'm always really tired when I finish an overnight shift.  I usually head home and just go right to bed."

"Well, I wouldn't want to go to bed right away," she said, deliberately looking me up and down.  "I'd want to have breakfast first."

"Gee - I'm just so tired that I'll be going right to bed.  You ladies have a good night, and make sure you drive safely on the way home.  Nice to meet y'all." I said, fleeing.

"I hope I get sick real soon so you can take care of me, Doctor Marcus," she called after me. 


The attending and a couple of the nurses saw the look of fear on my face as I came around to their side of the glass enclosing the nursing station, and started laughing.

"I was going to warn you, but it was too late," he said, then clasped his hands together and made big dreamy eyes: "Is that nice Doctor Marcus going to be coming back in to see us?"


I caught strife for it the rest of the shift.  How come I can't have that effect on women when I actually want to?