By BirdStrike M.D.
I walk in for a shift and sign up for my first patient. To my surprise the patient sitting on the bed is my friend and co-worker Dr. Jerry. Before walking into the room, I notice from afar, his hand is grotesquely swollen, black and blue. I walk in to the room and say with a chuckle, “Jerry, what the heck are you doing here? You are supposed to be on vacation. Wow, you must really love this place?”
Jerry happens to be what we ER doctors refer to as a “machine.” He can walk into an emergency department in chaos and seemingly singlehandedly bring it under control, with what at times seems like superhuman brute force. Of all the ER doctors I’ve worked with, if anyone was truly born to be an ER doctor, he is. “Close the door,” says my patient, Dr. Jerry.
“What happened? Did you fall? Your hand looks horrible,” I ask. “Good thing you’re on vacation starting today, because with that mangled paw you’re not going to be doing any suturing or any other procedures that require more than a stump for a hand for quite a while,” I add.
“You can’t tell anyone. It’s embarrassing. You promise?” Jerry asks.
“Sure man, no problem. It’s between you and me and the HIPAA Gods. What happened?” I plead.
“You know my luck, and the black cloud that follows me, right? Well, I walk in for an overnight shift a few days ago and the department’s dead. For once in 10 years, there’s practically no one in the whole department. In fact, there was no one in the whole department. I sit down and I’m thinking: this is weird. Maybe for once I’ll have a great shift and just sit on my butt all night and not get crushed with a constant onslaught of chaos. Just then I look up, and into room 11 walks in,” says Jerry changing to a tone of doom, “Gary the Medical Malpractice Lawyer.”
“Gary the Guillotine? No way! I thought we were the ‘most negligent group of physicians he’s ever seen in his career’? Funny how he has sued, or attempted to sue just about every single doctor in this group and when he’s sick he comes here?! You’ve got to be kidding me? I’m sick to my stomach even thinking about it,” I say, trying not to gag on my words.
“Yeah, it was unbelievable. You should have seen this guy. Yucking it up with Jane, you know, Jane the new nurse?” he says.
“No. I haven’t worked with her, yet,” I say.
“You know, Jane, the one that just finished nursing school?” Jerry explains, raising his eyebrows.
“Oh…..Yes. How could I forget? Jane…,” I answer.
“He was all over her like a dog on a rib-eye. What’s he, 50 years old, and she’s what, barely of consenting age? Anyways, I signal to her to get out of the room and come talk to me before I go in, because in NO WAY is it even remotely possible for me to go in the room and treat this guy objectively. Do you remember what this guy did to me?” Jerry asks.
“He tried to sue you, like most everyone else at this hospital,” I answer.
“Yes, and during a deposition, he asked me about the fact that I disclosed having been treated by a psychiatrist briefly, on my medical license application,” Jerry began to explain.
“So what? I think you mentioned that before. You took Prozac for 2 weeks or something. Big deal,” I say. “You’re fine now.”
“Well, it wasn’t a big deal, until the next day when somehow, magically the front page of the newspaper shows up with the headline ‘Mentally Ill Doctor Allowed To Work In Local ER,’” he says.
“Isn’t his wife an editor for that paper? You’re saying she leaked it. Wouldn’t that be illegal? When did this happen? I ask, somewhat puzzled.
“This all happened before you came to this job. They eventually retracted the story, but not until I almost lost my job over that garbage, not to mention having been humiliated. If it wasn’t illegal, it should be. It certainly would be for you or me to pull any of that crap, if the tables were turned. Not to mention the fact that he tried to use that to destroy me in the malpractice case,” says Jerry.
“Was that the case with that child, where no one did anything wrong, but there was just a very bad outcome?” I ask, disgusted.
“That’s the one,” says Jerry.
“So what happened last night? I need to know,” I plead.
“So, I signal to Jane to come out of the room and ask her what he’s here for. ‘Feels funny,’ is his chief complaint. I tell her I can’t treat him. ‘You have to,’ she says. I ask her, ‘Is there anything, ANYTHING, about him or that he’s complaining of that could be an emergency of any kind?’ ‘No,’ she says. I have her go back, check his vitals again, and ask him every question known to man about chest pain, shortness of breath and the works. All he tells her is he ‘feels funny’,” continues Jerry. “So I’m freaking out. This guy tried to ruin my life. I can’t possibly take care of him objectively, and he has nothing that suggests an emergency, whatsoever. EMTALA says he needs to be seen but not now, or by me, unless he’s got an emergency. Plus, the nurse screened him. I hurry up and call Bob (ED director) and tell him he’s got to come see this guy. Naturally, since it is 2 am, he tries to tell me to suck it up and treat him, and ‘just be objective’. After I explain the situation, thank God, he realizes he’s about the only one in the entire group that hasn’t been sued by this guy. He agrees to come in, and says he’ll be here in 10 minutes,” Jerry explains.
“So he came in then? Everything was cool, right?” I ask.
“Not exactly,” Jerry says hanging his head with a defeated laugh. “Well, 10 minutes go by, and we’re still waiting for him to come in. So, the Jane explains the situation to Gary the Lawyer, that by her screening exam he’s stable and a second doctor will be here any minute. You know what he tells her?” Jerry asks. “He tells her he wants ME to be his doctor because he thinks from reviewing many charts and cases I’m the best doctor in the group. Can you believe the audacity?”
“After reviewing cases, you are the ‘best doctor’ in the group? You’ve got to be kidding me. That’s absolutely unbelievable,” I answer, dumbfounded.
“Well, I’m still refusing to see him at this point. I’m looking at the clock waiting for Bob to show up. Amazingly enough, not one patient checks into the department in the entire time. It seems like it’s taking forever. It’s like this horrible stand-off at 2 in the morning with me and my horrible nemesis caught in this horrible jumbled ethical ball of EMTALA-HIPAA-Emergency-Medicine-goo. Then, the nurse comes to me and says, ‘Something’s not right with him. His sat was 98%, now its 89%, and dropping!’ Right then, we both look to the room and his head is purple and he’s slumped over taking guppy breaths with a HR of 140, and BP of 60/40.”
“N o . H e . D i d n ’ t. He coded on you didn’t he? Leave it to this guy to come into your ED, single coverage and code, on you,” I gasp, with a face palm. “Un…be…lievable. So what happened next?” I ask, riveted.
“Well, for a hundredth of a second, as I looked at him trying to die, I asked myself, ‘If the tables were turned, and I was dying and the only one around was Gary the Lawyer, would he try to save me? Or if destroying me would lead to him winning a huge case or furthering his career, would he just turn and walk away? And before I even had a chance to answer the questions, I’m in the room bagging him full of oxygen, calling out orders and robotically doing what I was trained to do, bringing Gary the Lawyer back from the brink. I look down and his trachea is so obviously deviated it’s just announcing itself right there without me having to even think to look for it. I take out my stethoscope and listen. No breath sounds on the right. He’s got a tension pneumothorax. In goes the 18 gauge needle in his chest and ‘Poof!’ goes the rush of air. And with that, I saved the life of the guy who tried to ruin mine.”
“No. Way. You’ve got to be kidding me. He lived? He’s alive? You’re got to be making this up,” I ask.
“100% alive,” says Jerry. “Not only that, he got his chest tube out and was sent home, awake, alert, walking and talking, with no deficits whatsoever; brought back from the dead, by me, the guy he sued for supposed negligence.”
“Wow. That’s the stuff you discuss in Medical School ethics class or watch in movies, but wow, it actually happened to you,” I said, shaking my head with a disbelieving laugh. “You really do have a ‘black cloud’ hanging over you. That’s unreal. Don’t ever transfer that black cloud to me, please.”
“With that, I decided that I’m done,” said Doc Jerry.
“What do you mean, done? And what does any of this have to do with your broken hand?” I ask.
“I was so mad at this whole scenario, having been put in this position, that on the way out the door I punched the wall so hard my hand exploded,” he says. “At that moment, I decided I can’t be a doctor anymore. That’s the last patient I’ll ever see, and the last life I’ll ever save. And this is the last trip I’ll ever make to an ER where I don’t leave in a body bag. That’s it. I’m done. I can’t tell you how good it feels.”
“No, you can’t do that. That’s irrational. Just take a couple weeks off, or even 6 months and just cool down, or cut back your shifts. You’ll start to see things more clearly. You’re burned out. It’s normal. You can’t quit over this. You were just doing your job. Don’t quit over this BS,” I plead.
“Splint me up and off I go,” he says. “I’ve got a one way ticket to paradise. I’m cashing out my house and moving away from this freezing tundra to somewhere it’s always sunny and warm and the pace is a lot slower. I’m not sure what I’m going to do, but I’m going to live dirt cheap; maybe sell suntan oil to tourists, start a band or sail the Pacific Rim. I’m going to go where the wind blows me.”
That was the last I heard from Dr. Jerry, for over a year. Then, out of the blue, I get a postcard from him. It read,
“Sorry I quit and left the group with no notice. I was burnt to a crisp and that last shift just broke me. I just couldn’t do it anymore. I had to be done. Life sure is good here in the Land Down Under and the year off has done me wonders. My new ‘career’ is great. Who knew refereeing women’s beach volleyball could be so damn rewarding, LOL!? It’s certainly much better than what I used to do. Oh, I almost forgot the best part: I sure wasn’t expecting it or counting on it, but my injuries qualified me for full own-occupation disability payments. I have to ask you a favor. Please, if you can, track down Gary the Lawyer, and tell him, ‘Thanks.’ Life is good. Life is very good.”
This author does not divulge protected patient information or information from real life court cases. Any post that appears to resemble a real patient 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 are fictional, and certainly HIPAA compliant. Artistic license can and will be used liberally as needed. If you want boring scientific case 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.