1999
This story was originally published by InterText in their Y2K issue. It was surreal and kind of fun to run through it in my mind before it all happened.
Some nights I feel like I'm the fucking grim reaper. It varies. I don't know why, 'cause when I go back over the numbers, they're about the same either way. Tonight seems like its going to be weird though, even though it probably won't.
I stroll in from the parking lot, safely ensconced in my totally illegal parking space. It's clearly labeled Ambulance Parking Only, and my beat-up little Saturn in no way resembles an ambulance. Still, the security folks like me, so I get away with it.
"S'okay if I park here for a little bit?"
"How long do you think you'll be?"
"Umm ... all night."
"Yeah sure, whatever. Have a good night, Marcus. Come out and have a smoke with us later, huh?"
"Oh, yeah."
Walk into the main nursing station grinning like an idiot. "Ah," I announce, "happy faces. I have entered into a bastion of strength." I clap my hands once and begin to chortle evilly.
The charge nurse looks at me blankly and shakes his head. "I'm going home. Good luck."
The off-going attending grins and blows bubbles into her coffee. "It's a zoo," she says, waving at the board.
"Zoo? What zoo? Just 'cause its Friday night and the idiots are out in force? There is no zoo. There is only zen - the zen of the mother-ship. We can do anything. We have the power . . . I don't like the way he said, 'good luck.'"
She contemplates her coffee, which is now starting to dribble over the edge of the cup onto the carpet. "You were dropped too many times as a child."
"As a child I was blessed. " I retort. She rolls her eyes, and a nurse wandering by snorts in contempt. I continue, not pausing, "blessed upside the head with a baseball bat."
She gives me sign-out, and then gathers her stuff. "Party time for this girl tonight," she announces. "Gonna go catch me something big and stupid that I can kick out in the morning."
"Have one for me," I tell her.
"A drink, or something big and stupid?"
"Whatever. Go. Escape while you can."
I survey my team. I'm lucky tonight - good residents, good nurses. I can suffer no harm. I tell them this, and they look at me warily. They're skittish, and I can't really blame them. Tonight is amateur night.
We see little things. A twisted ankle. A head-cold. Back pain, some real, some weaselly.
"How long has your back been hurting you?"
"I injured it at work three years ago. I've been on comp ever since - chronic pain."
"I see. And how can we help you this evening?"
"I ran out of my medicine. I need you to write me a prescription for a refill."
"I don't mean to sound cynical, but are you trying to tell me that in three years of requiring narcotics for your chronic pain, you haven't learned to anticipate when you're going to run out in time to get your doc to write you a refill?"
"Well, you see, he's out of town."
"What's his name - I'll call his answering service."
"Uh - I don't remember."
"You don't remember the name of the guy who writes your pain prescriptions?"
"I just started seeing him."
"Who did you see before him?"
"Um . . . "
It is demonstrated to us once again that profoundly drunken Rich People are The Worst.
I read the line on a woman's palm - an intern's suture job. "Huh. Why did you put in so many stitches?"
"Well you see, the ones I was putting in kept pulling through the skin."
The wound should have five, perhaps six sutures. "Hang on for a sec, before you take down the field," I tell him. Grab myself a pair of sterile gloves and the iris scissors, counting to myself as I cut them out. They're all about a millimeter from the wound margin grabbing only skin, no meat. Of course they were pulling out. I remove twenty-one stitches, and then put one new one right in the middle of the wound, taking a big bite, then tie it while the 'tern watches.
"I would like you to put four more stitches in, just like mine, two on either side, then get one of the nurses to show you the best way to dress it. Better not ask her to dress it and walk away, 'cause she'll just laugh at you."
"But - "
"Four more," I say, holding up four gloved fingers.
"You see, I - "
Now the patient gets into it. "Honey, I think he wants you to put in four more, just like he said." She holds up four fingers of her other hand, grinning at both of us.
We see that people who don't take their seizure medicines for various reasons sometimes have seizures at inopportune times.
The lights flicker at midnight. It happens from time to time, usually transient. We have hospital-wide backup generators just in case, but "please not tonight," I think to myself, "we're too damned busy for this." Its New Year's Eve. Dire predictions of millennial wrath have been so pervasive that none of us have really been hearing them. I figure that if New Year's Eve is generally amateur night, this one should reign supreme.
And now the goddamned lights are flickering.
Down the hall there's a nurse standing at an open breaker box. He grins like a wicked child. "Just kidding - "
Dude comes in all drunk and stupid from a nasty car crash, oblivious to his unstable open right ankle fracture. Seems that phone pole just jumped right out in front of him . . . I play games with the trauma team, for the airway belongs to me and my people.
Trauma 'tern says, "pupils are equal and reactive."
His airway is fine, evidenced by his mindless babble. No intubation for my resident, alas.
Trauma wants to scan his head, I'm hip - not that they need my approval.
I take a quick peek in the peepers to confirm trauma-boy's findings and say, "er - his pupils look equal, but they aren't." I'm trying to be political. "And how about this penetrating globe injury with the vitreous leaking out of it?" Something has poked a hole in Mister Dude's eye.
Trauma says, "oops."
Mister Dude is drunk and moaning and generally being a pain in the ass so I suggest sedating the shit out of him, 'cause I reckon every time he hollers, the pressure inside his eye is going up, which causes eyeball goop to slop out onto his face.
But it's, "No no, we want to follow his neuro status." Ouch: I am over-ruled. Their patient, they win. I am but a lowly consultant.
So in the CT scanner, he does a fish-flop and finds the floor. I can't resist. "Bet that was good for his eye . . . "
Trauma glares at me. Hell, what does he care? His eyeball isn't popped, so he can glare just fine.
"We can fix this for you," I tell him. "Look at my boy here. He wants nothing more than to help you to make Mister Dude more comfortable." I look at my resident, he nods vigorously. "Think of it this way: we'll give him a little something for your nerves, okay?"
They acquiesce and Mister Dude gets strong sedatives, paralytic drugs, and a nice plastic tube which connects his throat to the ventilator. My resident gets a procedure. Problem solved. Another blow for freedom.
The department is busy. Crazy. Typical Friday night.
We learn for the umpteenth time that unassuming little guys who calmly tell you, "I can't really describe it to you doc - it just hurts real bad," generally have something very badly wrong with them.
Another trauma comes in around one in the morning, hard on the heals of Mister Dude and his wacky leaking eyeball. Its billed to us as gunshot wound to the neck by our dispatchers who give us the three minute advance warning.
The patient is drawn and thin and appears to be having rather a hard time breathing. Once again, the show belongs to the surgeons. I stand at the side, next to the trauma attending, with whom I swap witty sotto voce wisecracks. "He'll have been standing on a corner, minding his own business," I say. The trauma surgeon grunts his assent - its uncanny how many folks get assaulted while minding their own business. We reckon that its far safer to be nosey and obnoxious, because those folks never seem to get hurt.
He has a single wound high up where his right shoulder and neck merge. "Breath sounds markedly decreased on the right," the senior trauma resident announces, while asking the patient, "What happened?"
"I was just walking up the sidewalk, minding my own business! I don't know," he says, panting. The trauma team rolls its collective eyes.
The chest x-ray demonstrates more or less what we expected: the place where his right lung is supposed to be is filled with a mixture of air and blood, indicating that his right lung is down, and that he's bleeding from somewhere. The bullet is low in his chest, probably sitting on top of his diaphragm. This does not surprise us: any bullet can goanywhere. You can deduce nothing on whence it came from where it ends up.
About thirty seconds later, the trauma team has inserted a chest tube while their attending and I watch with half an eye. Blood and air come gushing out, and his breathing gets better.
His blood pressure is terrible though. The surgeons cackle quietly in their minds while making frantic preparations to get him to the operating room so they can take a look inside and fix him.
Minutes later, the trauma team is gone, leaving in their wake a puddle of blood from the chest tube and bits of throw-away medical paraphernalia strewn about the room. I'm staring at the mess when I feel a large cold presence at my shoulder. Cold because he just came in from outside, and large because - well, because he's just a damned big cop.
"They're in the o/r," I tell him. "He's sick but he'll probably live."
The cop just stands there, surveying the room.
"Uh - what's the story on this one, anyhow," I ask.
"Witnesses say that he was just walking up the street minding his own business," the cop says. This is where the language of law-enforcement overlaps the language of emergency medicine.
"Aw, come on. What do you think happened?"
He swivels to look at me directly. "I think that folks were shooting guns into the air to ring in the millennium. I think he was hit by a falling bullet."
"Well fuck me," I answer. "Go figger."
Three teenagers are brought in by medics, drunk. Too many shots of some alcohol-laden syrup called "Hot Damn."
"How much did you guys drink, anyhow?"
"I los' track after we finished off the tequila," one of them slurs. Another chimes in, "You won' pump our stomachs will you? Omigod, you won't tell our parents -" He cuts himself off to vomit impressively into his lap.
The nurse in the room wrinkles her nose at the mess. "Honey, you're pumping your own stomach just fine. Your folks are in the waiting room."
I call the radio station at five-thirty in the morning. "Can you please play Lunatic Fringe? Or maybe Might as Well Go for a Soda?"
"Who is this?"
"The E/R at Pittsburgh General. We need it. Bad."
At six-thirty in the morning, I walk outside. Things have calmed down considerably. The drunk kids went home with their folks about an hour ago, only vaguely aware of the parental wrath that will descend upon them when they awaken with horrible hangovers. There are a couple of folks with belly-pain which may or may not be from overindulgence, and one person who is about to be whisked off to the cath-lab so that his heart-attack can be aborted by the interventional cardiologists. There's a guy who woke up with absolutely no clue how his hand got broken.
Things are Under Control, and I get to go home in about forty minutes. It's cold as hell out, and utterly clear. It's going to be sunny today. One of the helicopters is cranking up on the heli-pad, dispatched to the scene of a car-crash about forty miles away. While fishing for a cigarette, I wonder: bad luck or another amateur?