What was the most challenging shift you experienced as an ER physician? Can you describe the details and reasons behind it?
07.06.2025 10:04
The next guy was a little more difficult. How the oncology nurses upstairs knew I was still in the ER at one a.m. is beyond me. I should have pretended to be someone else when they called on the phone. I could have easily lied, and in retrospect, it was a mistake not to, because things can go wrong really fast when I value someone else’s sanity more than my own. It’s a habit left over from when I could actually pull a twelve-hour shift on my feet and still play golf the next day—if I’d played golf. After fifteen years of night work in the ER, I should have gotten a little better at lying, if for no other reason than self-preservation. But at that point, I could only pull it off with crazy people, and my nurse friend wasn’t crazy when she asked to come upstairs and tend to the husband of a woman who had just died after a long and lingering illness. Really bad timing. The woman had been trying to die for about three years and acutely dying for about five days and she finally gave in to death just when I was heading out the door. I was beginning to see a pattern I didn’t like.
“Sorry, I fell asleep in my office,” I lied.
By now it was after five a.m. and I was about ready to grab a stapler and close the wound myself.
What does the stink of the skunk look like? Why would it be dangerous?
I was even more intrigued, however, by the man’s stoicism and presence of mind. With his lower limb hanging precariously by a lingering ligament, he used his hands to circle his thigh to make a pretty good tourniquet, and that’s what he was doing when the paramedics arrived on the scene. He must have known what was going to happen to his leg. Yet the man never complained of pain. He never flinched. He never acted as if he was going to lose a leg. Did it matter to him? Or was he one of those guys who can power through anything? And why was he living as a social isolate in a cheap shack buying baloney at 2:00 a.m.? A real oddball. And now, a one legged one.
This is not a lie. This is not an exaggeration. I am not making this up. Someone may be weird enough to make this stuff up, but not me. After chasing him from the house, the woman checked out her two-year-old daughter in a different room and found out that her son might have been kinkier than she thought, and now she wanted to have the little girl evaluated for molestation.
It’s always a little embarrassing to me to be quick-stepping around the ER trying to help out a guy who won’t ever be stepping at any speed again. It seems like I ought to act a little more subdued so as not to make him jealous. But when I walked in the room and tripped over his wheel chair, he just laughed and called me a clumsy AB—Able Bodied—the term those who don’t have able bodies use to describe those of us who still do. It helped take the edge off life for him a little, making fun of my momentary clumsiness while he lives his whole life defined by his own. I took care of him in more of a social visit than anything else, as he was doing well for a quad—just another urinary tract infection. We visited for a short time, catching up on each other’s lives, I said good-bye and headed out the door.
We were also encountering some coincidental occurrences here. The first mom, the one who had confirmed her own sexual assault through her olfactory sense, appeared to feel that she and I had somehow forged a bond based on the informality of our interview. I suppose after telling me the details of her story it was hard for her to go back to a more formal relationship so at this point, whatever happened next should not have been a surprise. In retrospect, following all the things that had gone on so far that night, it would have been unbelievable if something bizarre didn’t reveal itself at that moment. Of course, it did.
The man had worked for the county for thirty-nine years, had a good pension, lived alone in a little house and only had one living relative, a sister who lived in Alabama. She was married and he couldn’t remember her name or how to contact her. I was wondering how a life could come to that. To have worked but not to have made friends. To have a sister but to have lost track of her in Alabama. To be living in a shack when he could have easily afforded something much better. It was strange, but it would have been a little too personal to start asking what the deal was when he was laying there with his leg ripped off.
It’s impossible to say which patient finally put me over the line that night. The competition was tough and, as luck would have it, the stakes were high. I was getting ready to go on a trip out of town with some friends who were gracious enough to wait until midnight, when I was scheduled to leave the hospital. Forgetting about all of the times I had to work late for one reason or another, we planned to do an all night drive to go camping in the mountains following my shift. My friends had no way of knowing, but they should have at least suspected something would go wrong, simply because it was important that it didn’t.
For Elizabeth, that was a dream date compared to her previous visit, when she insisted she needed to be given an exam because she had been laying eggs for three days–that’s right, laying eggs for the last three days. So we had placed her into the pelvic room (after all, the pelvis is where eggs come from), and put her in the stirrups so the doctor could do the appropriate exam. When he came into the room and started to take a look between her legs, Elizabeth jumped up and ran from the room screaming indignantly, “I came here to get my asshole examined, not my pussy. You guys are all crazy. I’m getting out of here.”
Before cell phones- a really long night and a really long story
The amount of paperwork I had left to do could compete with a major metropolitan phone book, and I knew it would be daylight before I finished it. That’s when Elizabeth, one of my regulars showed up. She was rather sedate compared to the last time I’d seen her, and not nearly as confused. She had missed a simple turn and crashed her car—totaled it according to the next wave of cops who came through the door. This information was met with dismay on my part, because I knew Elizabeth lived in her car and that she was now homeless. Homeless people are social work people and it would be up to me to find a place for her. Both my sympathy and my energy were pretty well exhausted by then, and I wasn’t sure what to do.
It has been said that a true ER veteran could plan a six-course meal while watching a patient throw his across the room in a reverse feast of projectile vomiting. That being the case, I could have planned the menu for the rest of my life around the weird collection of patients showing up at the time I was supposed to be heading out to a few days of peace in the wilderness.
Then things got worse. I checked the clock. It was three fifteen. I imagined my friends, sleeping in my truck. Or complaining in my truck. Or maybe, by now, kicking my truck, but at least having the luxury of venting their frustrations while I was sinking faster under mine.
The four-year-old girl who had a caretaker insert a digit in her rectum went first. It must be have been very confusing for her to have the twelve-year-old neighbor stick a finger up her anus, especially when that neighbor had been entrusted to protect her from things like that. Very confusing. Why would someone want to do that—and where had the twelve-year-old learned it? Had someone done it to her, or did she watch cable TV some night when her parents were asleep and try to mimic what grownups seemed to enjoy doing? Who knows anymore? Not me, and I sure wasn’t going to find out at three in the morning. There wasn’t time, and the four-year-old just wanted to go to sleep. The police wanted us to do the physical exam and get the evidence forms completed so that they could get back to the station and finish their paperwork by dawn. I presented the idea that, while it was probably true the twelve-year-old had done it, it certainly could have been just as true that the twelve-year-old had been a victim too, and she was just passing it on down the line. This is a well-documented phenomenon and worth looking into—later.
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Finally though, something went my way. It turned out that Elizabeth had moved into a shared living situation with other schizophrenics and had a place to stay. I didn’t want to give much thought to the viability of that living situation, I just wanted to get rid of her. A quick cab ride and she was gone. Gone into the sunrise that was now appearing over the local mountains.
“What happened?” they asked.
It had been a memorable night with some really great quotes, some unbelievable lines, some incredible coincidences, some tragic events, some ongoing craziness, and some outright stupidity. I was glad to leave it behind. When I got home and found my friends asleep in my truck, I woke them up and told them we were ready to leave.
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As bad nights go, it was definitely one of the worst. Actually, as bad nights go, it wasn’t one of the worst, more like, as strange nights go, it was one of the strangest. While the short shift I dreamed of slipped into the nightmare I hoped wouldn’t occur, all of my meals were eaten standing up, and even a trip to the bathroom seemed a luxury. I was happy to get the free junk food they give us when it gets busy, as I knew the basic oral fix it gave me would be the only pleasurable thing I would enjoy for a several hour period. That’s a long time to go when every minute is a battle to try to get control over life and limb, or at least sanity and insanity. Most times in life, apart from war and other such disasters, there are moments of calm, a brief time to gather one’s wits, if just to rest up for the next onslaught. Not that night. It was constant onslaught. Those are the nights we have candy for dinner and chase it with a Coke while walking between patients. If the patient is unconscious, and sometimes we secretly pray for it, we might even eat while tending to him.
If I had told them the truth, they probably wouldn’t have believed it. You probably don’t either.
The little girl with the puffy and bleeding face was another case of WPWT, born in to the wrong family, a family that used violence to settle differences, even minor differences. Dad got angry about some perceived slight. Maybe Mom looked too good, another man noticed her, and in a jealous rage, Dad started hitting her. The police indicated it was standard behavior at this home. Unfortunately, during the beating, Mom had the little girl in her arms and zigged when she should have zagged and the kid took a roundhouse blow to the face. She immediately threw up on her mother’s chest just as her half-brothers came home. They were fresh from some gang activity and pretty pumped up with a lot of negative energy, so they beat dad into the ground, and by then the police arrived. I understand that they made no timely effort to stop this last bit of violence. It saved them the hassle of doing it themselves and then having to do a bunch of paperwork, possibly getting suspended and all that.
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“See what you made me do this time. When I get out I’m really going to kick your ass.”
I never got a chance to fully ponder the meaning of these coincidences. I finished my paperwork and was on the way out the door when a paramedic gurney clipped my hip, knocking me back against the wall. On the gurney was a little girl, her faced puffed and bleeding. Mom was at her side, tearful and anxious, along with more cops, from yet another city. At this point, we had more policemen in the ER than we had staff, and it was starting to get comical as two of them renewed a friendship they had begun in the police academy eight years before. I’m sure someone somewhere would find it interesting that we would have sexual trauma night and police reunion night in the ER scheduled at the same time. On top of all that, it was four-thirty in the morning, and my friends were still waiting for me. At least I hoped they were. By then I was hoping my friends were still my friends.
The police told me the last words from Dad as he was taken away in handcuffs constituted a threat to his wife’s well-being.
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The kid turned out to be okay; just a lot of swelling. But Mom was going to need stitches for the severe laceration on her forehead. She also came up with a pretty memorable quote.
“I was laying in bed with my boyfriend half asleep and I felt a strange sensation. At first I thought it was my boyfriend but when I woke up my ten-year-old son was finger fucking me. I jumped up and he laid down beside my bed like he was asleep and I thought maybe I just dreamed it. But it seemed too real, so I grabbed his hand and pulled it to my face and when I smelled his finger I knew it wasn’t no dream”, the mother said.
The husband was a bundle of mixed emotions, relieved that his wife had finally gone to a painless place and sad he had been left behind. We talked about that for a while and he seemed to be able to work it out in a normal fashion. But it did take some time and certainly some energy on my part. When I finally got back downstairs it was almost two a.m. My friends were still at my house waiting in my truck and there was no way to contact them. I figured they were a bundle of mixed emotions by then. Tired, angry, frustrated, confused, feeling the need for some candy. I could relate.
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“I’m afraid of needles, can’t you just bandage it?”
“Bob, Bob, come here” the mother whispered. “That little girl with the rabbit. I saw her and her mother in downtown LA two months ago. We were both waiting for the bus at Third and Spring. She was with her mother and we all talked like we were old friends. They were both very sweet. But they were both very off center, if you know what I mean”.
I ran back to the room where the other cops, the curveless child and her family were. The cops told me the patient had previously been found fondling the penis of a nine year old and sometimes encouraged the children in the apartment complex to dance naked and move their pelvises in a suggestive manner. This was a very suspicious history, and I knew for sure she hadn’t picked all of this stuff up just from watching MTV. When I asked her if she knew what sex was, she hugged her stuffed rabbit, cried a little and shook her head. She didn’t know what it was but she did tell me she had never had it. I thought that was a rather interesting concept, sort of like, I hate tuna sandwiches but I’ve never really tasted one. So when I suggested to her that we wanted to make sure no one had taken advantage of her by having sex with her when she didn’t know what it was, she couldn’t escape the simple logic and allowed us to do an exam. We found no obvious physical damage but during the exam she revealed her father had fondled her breasts, or what there was of them, the act of a true pedophile. We were encountering some really sick occurrences here.
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WPWT- wrong place, wrong time. Some things come down to just that. No place to put the blame. No mistakes. No contributing factors. Just bad luck. The unfortunate old guy brought in by paramedics had been standing on the corner waiting for the light to change. He had just walked to the convenience store to get some baloney and bread and he was on his way home. At the very same time, someone lost control of a car, bounced off a bus, slid sideways toward him, and while he watched, pinned his leg between a light pole and a sharp bumper. Very sharp. Upon arrival in the ER, there was just a small amount of tissue holding the bottom part of the leg to the top and we all knew we wouldn’t be able to save it.
I met three pairs of cops coming in. Three pairs of cops from different cities. Three pairs of cops looked right at me and then at the women and children with them and then back at me. Then they looked at each other and wondered who would be first in line to get their bad situation taken care of and who would be stuck watching the sun come up. I had to be fair about it and handle them all at the same time. That’s when the night really started to get strange.
The waif who was next in line had come from a small town about a half-hour away in the San Fernando Valley (thanks, officers, for passing six other hospitals to find me at three am). The police had been to her house several times in the past for allegations of sexual improprieties, but until tonight, nothing had ever come of it. She was fourteen years old and had the body of a ten-year-old, totally without curves. She also had the mental development of a five-year-old and, according to the police report, was frequently seen standing in front of her large living room window naked and masturbating. The neighbors had grown increasingly tired of her screaming “Daddy’s fucking me again,” and began to call the police on a regular basis. On this particular evening, the neighbors swore they heard the mother tell the father that if he was going to do that he might as well marry the girl. It was at that point I needed a break, so I skipped this sordid weirdness and went directly to the next waiting family.
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The cabbie that got tossed out of his car when it rolled over several times looked like he was going to be a real mess at first. A lot of blood. A lot of groaning. But, as is often the case, when everything was cleaned up, X-rayed, sutured and put in fresh clothes, he wasn’t so bad after all. A cabbie always has other cabbies around, so it wasn’t even that hard to get rid of him. Lucky man, I guess.
He went quickly to surgery, and I only had a quadriplegic left to see before I would be able to leave. I knew the patient from when he first became a quad, a kid who drove his truck off a cliff one afternoon in a momentary lapse of attention. Now, he can’t feel much of his body or do much with the parts he can feel. He always serves as a real reminder to me how fragile it all is and how lucky I have been so far surviving some of my own bonehead mistakes. Given the situation with the previous patient’s leg, it really wasn’t necessary to have another reminder.
What are the chances of that? Two sets of people involved in sexually weird circumstances, in the same hospital, having come from towns twenty miles apart, in the middle of the night, for essentially the same reason, having met before on a bus bench where one mother observed the other as being “very off center.”
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