By Birdstrike MD
I saw a story in the news about something that happened to an ER doctor. It reminded me of something that had happened to me before, so I started writing about it. Then my imagination got a little bit carried away. So, let’s just say parts of this story are absolutely true, and other parts are, well…just read along.
I walk in for my ER shift. There’s a letter in my department mailbox. It’s a hand written letter from a patient. I open it,
“Hey doc! I just wanted to thank you for taking care of me last week. It was one of the low points of my life and I really had hit rock bottom. You’re the first one to talk to me like a human being. You convinced me to get help. They finally let me out. Thanks, again. You saved my life. You’re a great doctor. We should hang out sometime.”
I remember the patient. I admitted him for severe alcohol intoxication, depression and suicidal thoughts about 2 weeks ago. It’s not that often that you get to start out a shift with a “thank you” letter, albeit with a bizarre request at the end to “hang out sometime.” In this ER game, you take every pat on the back you can get, because they don’t come every day.
I walk to the pit to see my first patient. First up is, “Broken wrist.” I walk into the room and it’s him, Jerry, the letter writer. “Hi, Jerry, what can I do for you today?”
“This,” he holds up his mangled right hand and wrist. “I got pissed off and punched a wall.”
“Wow, you sure did a number on yourself. What happened?” I ask.
“Did you get my letter?” he asks.
“Yes. Why do you ask?” I wonder aloud.
He stares at me silently, and uncomfortably long. “Oh, I don’t know,” he trails off, staring through me. “Just fix me up, and we’re good.”
I walk out of the room. That was weird, I think to myself. I put in an order for x-ray of the hand and wrist. I put that plate up in the air to spin, and move on to:
Jerry’s x-ray is done. Wow. He’s completely shattered his wrist and 4th and 5th metacarpals in his hand. I haven’t seen a one this bad in a long time. I walk into his room. “Jerry, you’ve badly fractured your hand and wrist. You’ll probably even need surgery. I’m going to call the orthopedic surgeon.”
“No. I want you to fix it. You owe me, big time,” Jerry says.
“No, you don’t understand. It’s badly fractured. You need a surgeon for this, a specialist,” I explain.
“Did you hear me? I said, ‘NO ’,” he says, gritting his teeth so hard they could shatter.
After years of seeing anything from little old ladies to psychopathic criminals, it takes a lot for a patient to truly bother me, but this guy is truly disturbing in a way that’s hard to describe. It’s time to get out of this room. “That’s the way it has to be for you to get the best care,” I say and walk out of the room.
As I get to the door, he yells, “This s—t is your fault mother f—-r! You should have called me back. I left my cell number on the letter for a reason. YOU shattered my hand and wrist. This is because of you. You save my life and then just TURN on me, like I’m nothin’?! You’re a PSYCHO!” I get out of the room, and call security to come stand by as he is splinted up and turned over to the ortho team, who I made fully aware of his psych history and behavior. A psych consult is obtained. He denies all suicidal or homicidal thoughts and is admitted. After a little while, he leaves the department and my shift ends, uneventfully.
I walk out to the car. It is 4:00am and deadly black in the parking lot. I look around. Are you sure they committed him, or did they splint him and sent him home? I ask myself. I look behind myself. There’s no one. I look ahead: no one. I move a little faster and get to my car and open the door and get in. I start the car and look in the rear view mirror. I pause. Could someone be hiding in the back of my car? I turn around to look. No, you’re just paranoid, I tell myself. You just had a bad shift. There’s nothing to worry about. That guy was harmless; all bark, no bite. I’ve dealt with much worse before, and regardless, he was committed. Or was he?
I get home and I’m exhausted. I get inside and go straight upstairs to check on my kids. They’re both angelically asleep. I go to my room and my wife is asleep. I get in bed and as soon as my head hits the pillow I’m out. Sweet restful darkness takes over as the light switch of my consciousness flicks off. Then, out of blackness blasts a crushingly loud,
WHOOP! WHOOP! WHOOP! WHOOP! WHOOP! WHOOP!
My wife shrieks, “Oh my god! The alarm! The ALARM! The kids, THE KIDS!” I jump out of bed. Adrenaline blasts through my chest. Holy s—t, I think as I run out of our room. I have no gun, no knife, no weapon, nothing. I run through our family room. I might take a bullet tonight, I think to myself, or maybe worse. I run upstairs to check on my kids and they’re asleep, despite the unbearable screech of the alarm. I look around at the windows: nothing. I run back downstairs. I check the back door and front door. Somewhere around the corner, someone’s going to be there. Just then, I remember: Jerry.
Oh. My. God.
The door to the guest room. Holy crap. STOP.
I tip-toe to the final room…
I put my hand on the door knob…
In silent slow motion I turn the knob and…
–WHAM- I open it into blackness and….
I creep into the bathroom. The shower curtain…
B E H I N D T H E S H O W E R C U R T A I N !!!!!!
The alarm falls silent. I hear my wife on the phone with the alarm company. There are no broken windows and no doors broken open. I check every closet, behind every door, under every bed.
A police officer arrives to check the perimeter of our house. “Just a false alarm,” he says. “Something must have triggered a sensor. Rest easy, all is good,” he says.
It might be “all good,” but it sure as hell doesn’t feel good, I think to myself. The officer gives us the “all clear,” and drives off. We put our kids in our bed and huddle in together with them. Neither of us sleeps a wink all night.
A few shifts later, I’m on the 5pm – 3am shift again. I walk into the ED and check my mailbox. There are no letters from unbalanced patients. That’s a good sign. I walk into the department. A nurse grabs me, “Cardiac arrest, room 2!” I bolt into the room. EMS wheels in a middle-aged looking female. They are doing CPR, and dripping with sweat.
“40-something female, cardiac arrest. Stabbed multiple times to the chest. No vital signs. Last vital signs were 30 minutes ago. We were about to call it, but we were at your back door,” says the paramedic.
30 minutes without vital signs? That’s basically DOA: dead on arrival. She’s intubated, she’s got 2 IVs hanging. The ET tube placement looks good. There’s 2 needle thoracostomies. Even an ED thoracotomy isn’t going to help this lady. There are no heart sounds. I put an ultrasound probe over her heart to confirm the obvious. There’s no effusion and no cardiac motion. She’s dead. “Time of death: 5:21pm.”
I step back and take deep breath. The blood has long since drained out of her gray face, which has a blank expression oblivious to the countless stab wounds in her chest. How tragic, I think. Okay, it’s time to shut that off, I tell myself. I need to notify the family and get back to work. The hardest part is about to come. I grab something with her name on it. I walk down the hallway. A police officer assigned to the case trails me.
“I’ll come with you doc,” says the officer.
My heart accelerates noticeably faster. It always does when I do a death notification, still, after all these years. It’s just something I’ve never gotten used to: delivering the worst news of someone’s life. I guess I am human. I open the door. There’s a man there, in tears, sobbing. His head is in his hands. He raises up, and
He’s got a KNIFE! In a second there’s a flurry, there are arms flailing, the cop and Jerry go down in a heap. The cop raises up heroically, and to my amazement he’s got him handcuffed, pinned face down, arms behind his back, and the knife is on floor across the room: Amazing. Just then the door blasts open and three more cops come in and haul Jerry off.
“Thank you,” I say to the cop.
“No problem,” he says. “Just make sure you remember my face if I ever come in on a stretcher staring up at you.”
“I absolutely will,” I say. I take the biggest deep breath of my life and somehow drag myself back out to the pit, to finish my shift. The rest of my shift goes smoother than usual, thank God.
After a much-needed 2 days off, I’m back to work at the hospital. I walk by my mailbox and pause. There’s a single letter there, hand addressed to me in jumbled handwriting. I open it. Inside is a picture of myself, my wife and kids from my Facebook account. With it, is a piece of paper with two words on it:
This author does not divulge protected patient information or information from real life court cases. Any post that appears to resemble a real patient, real person, real co-workers or trial can only be by coincidence. This author does not post, has not posted and will not post factual identifying information about real patients. To the extent that any post is based on the real life experiences of the author, names, dates, ages, sexes, locations, diagnoses, and all other factual information are routinely changed to the extent that they should be considered completely fictional, and certainly HIPAA compliant. Artistic license can and will be used liberally as needed. If you want boring scientific cases presentations, read a peer-reviewed journal. Any opinions expressed here are of the author alone and not those of Dr. WhiteCoat, my employer or any of the hospitals with which I am affiliated.