Agraphia Medical Tragicomedy



Last week a man was rolled in to the ER, although I hesitate to call him a man. He looked more like a mummy; lips shriveled, eyes sunken, arms and legs even wrapped in gauze to cover his numerous decubitus ulcers. He had suffered complete and total anoxic brain injury months earlier; there was nothing left of him but a physical husk. Every single physician and nurse dropped what they were doing to stare incredulously as he was wheeled by. He was death incarnate.

The medics, with a wry smile, handed me his chart from the nursing home. Handwritten, on a single blank sheet on top of the chart was a family member's scrawl, underlined three times and followed by a plethora of exclamations.


It became quickly apparent that he was much sicker than his chronic state of nearly-dead. Heart rate was up, blood pressure was down. We sat around for a moment, twiddling our thumbs. He was clearly going to die no matter what we did. The "right" thing to do from a legal standpoint was to rush him up to the ICU, flood his system with antibiotics, take him to the operating room to slice out all of the decaying flesh, and pound him with fluids.

The "right" thing to do from a medical and humane perspective, however, was to let him go. I would add "peacefully", but that opportunity was lost months before when we stabbed a breathing tube through his neck, shoved a foley up his urethra, a catheter up his rectum, and a feeding tube through his stomach in the name of Good Medicine. So, instead, I pulled the family aside to talk about end-of-life care. I wish I could say it went well.

"I'm sorry to tell you this, but there are two ways he can die tonight," I said quietly, "peacefully, with morphine to make it painless and comfortable, or with the ICU physicians cracking ribs during CPR, pushing painful medications through his veins, and shoving you out of the way during his last moments so he can't be with his family."

The daughter looked at me with a distasteful look. "Well, we goin' home, so it's between him and God now," she scoffed, "so y'all better do everything for him. I got faith he'll pull through. Here's my phone number in case anything happens. If it's busy jest call back later."

And so, he went to the ICU. Predictably, his heart stopped beating, ribs were broken during CPR, needles were stabbed into any remaining veins, and no loved ones were with him when he died. The phone was busy. They stopped by the hospital late the next morning with a bag of Dunkin Donuts to sign the paperwork.

Is there a moral here? I'm not really sure. I suppose I can only speak for myself when I say - vehemently - that I would never want to go that way.


The Endless Tide Of Unwashed Humanity

Faceless children throng through the doors of the Peds ER; parents, illnesses, charts all flowing into one feverish, runny-nosed amalgamation.

The waiting room is full of these kids. Anyone who didn't have the flu before, does now. It takes 7 hours to be seen, plenty of time for snotty hands to wipe all over the tables, the chairs, the playthings.

I vaguely listen to my voice on autopilot, droning on about the benefits of motrin and tyenol for fevers. I'm surprised to hear myself lose patience with a particularly insistent mother who wants her daughter hospitalized for a fever of 101.3 and a cough. Her kid is fine. She won't take no for an answer. We get security to escort her out.

This isn't fun. At one point I see 8 children in a row who I diagnose with the cold. The monotony is broken by a child with a cut on his finger, but he starts screaming the second I enter the room. We have to sedate him before I can sew it up. He hates me for it, and his mom judges my repair every step of the way. I look too young, she explains. My next 5 patients all have the cold. Nothing about this is enjoyable or fulfilling.

The shift ends with a whimper, as we finally clear out the waiting room 15 minutes before I'm scheduled to leave. My last patient is a kid with a cough. I send him home with tylenol for the fevers. The parents can't believe they waited eight hours for me to tell them that. I can't believe they did either.


Yes dear, you are.

A few weeks back I had to leave our med school tailgate to put in a shift at the urgent care. While I was truly saddened by my inability to contribute to the shotgunning of copious beers, alas, some of us are productive members of society. Then again, I'm of the mindset that shotgunning beers at tailgate is productive, but that's a debate for another time.

I had a pretty great shift, mostly because drunk college kids were brought in for various and sundry complaints†, and they were stoked to see the school colors under my scrubs. Halfway into the night, though, there was something... different. Cruising around the corner, I immediately noticed two things.

Firstly, my nostrils were assaulted with the pungent odor of vast, unimaginable quantities of shit; a horrific wall of feculent odor that knocked me backwards. This was shit to be reckoned with. This was shit that didn't take "no" for an answer.

Second, there was a very attractive sorority girl in school colors and butt shorts screaming blindly "I'm NOT as DRUNK as you THINK I am" at the nurse who was unsuccessfully trying to start an IV.

The incongruity of these two simultaneous events was difficult for me to comprehend, so I used my carefully honed powers of medical observation. "Ah, there's the problem" I thought to myself, "that lovely young lass has shat herself".

I mean, folks, I didn't realize you could even poop that much††. It was all over the poor guy drawing blood, the bed, the floor. It was splattered on the wall like a Jackson Pollock painting. It was a veritable cornucopia of fecal matter. It was Shitterhouse-Five.

That, my friends, is why I both love the ER and could never make it as a nurse. We love you so very much, you don't even know.

† If by "various and sundry" you mean "solely related to alcohol and the imbibing thereof". Pearl: if a piece of a broken beer bottle pierces through the insole of your Chucks, your antibiotics must cover Pseudomonas Aeruginosa.

†† let alone a girl who couldn't have weighed more than 90 pounds.