ER nights – always more than meets the eye

Sometimes a hot gall bladder is just a bag of bile and stones, and other times it is a lesson on life because every patient in the ER is much more than the ailment that first meets the eye. If you look a little harder sometimes you see more of the patient, and sometimes you see more of yourself.

Case no. 1: Eight-year-old who fell from a tree, got a concussion, fractured his skull. I did not tell the parents that they almost lost their son that day, because the look in their eyes said they had already stared at that abyss. His case reminded me, as I reminded them, that bad things happen in a heartbeat, right out of the blue, before the scream of warning or horror can even leave our lips. That’s why we buckle up, check the batteries in the smoke detectors, put latches on the doors at the head of the stairs, make the kids wear their bike helmets even if they whine like politicians caught redhanded, and lock the guns away where kids have a hard time getting at them. There but for a moment’s precaution can go the love of a life.

Case no. 2: Cut finger with a knife. Boring – seen it a million times. This finger was attached to a writer, however, a guy like me putting ideas to paper and hoping they are worth reading. I sewed, he talked, we bonded. He has sold books; he may have been bleeding but I was jealous.

Case no. 3: Priapism, an erection that wouldn’t quit after five painful hours, courtesy of one of those new drugs for erectile dysfunction, and a reminder of how often big trouble starts as just a bit of fun. The ads aren’t just joking when they say come to the ER if this happens; there aren’t many emergencies for a penis but this is one of them. The world would stop laughing at the jokes about how to treat priapism if it saw the real treatment.

Case no. 4: Another cut finger, this one belonging to a boy of 10 whose finger got caught in his bike chain. It was hard to tell if he hurt more because his fingertip was shredded or because his buddy the bike had turned on him. He would have been just another finger laceration but the smart nurse asked his mom about his family; turned out he was one of five kids whose dad – her husband – had been killed 18 months before in a car crash.

I sewed and we talked about how I was one of six kids whose dad also died suddenly, when I was about his age. He asked if we had turned out OK, and I said we did, after we struggled for a while. He asked if it still hurt to think about it, since I wasn’t a kid anymore, and I said “Yes, but not nearly so much as before.” We agreed the pain of losing your dad, although it never goes away, really does get better over time, though some days it hurts like a finger caught in a bike chain. After he left I thought, sometimes fixing a finger is just fixing a finger, but sometimes a doc gets lucky enough to also do a little mending of a wounded heart.

Case no. 5: Depressed and suicidal, drug overdose. There is perhaps no pain worse than that of the suicidal psyche, tortured as it is with the rack of depression and the thumb screws of hopelessness. Suicide is one of the most common causes of death in America, and is the heart attack of the mentally ill. ER docs fear true depression because every depressed patient who leaves the ER could come back suddenly and unexpectedly, done in by their own hand and dead on your ERwatch.

Case no. 6: “I can’t poop, and I haven’t moved my darn bowels for five days!” Physicians call that constipation, but when you are an 82-year-old woman in misery because your colon has gone anal retentive, the word “constipation” just does not adequately convey how you really feel. (Probably nothing printable in a family newspaper would.) Old age is a miserable SOB when it conspires to screw up simple, important things your body used to do without a second thought. It used to produce a good BM every day or so, let you walk without pain and stand up straight, and sleep through the whole night without getting up to pee. When the body gets old it seems to turns on you, like a favorite bike that chews your finger. Simple bodily things going awry also remind us that living alone and old makes one feel doubly vulnerable, like being alone and female when the car tire goes flat at night.

Case no. 7: Eighty-nine-year-old with belly pain. I hope I look that good at 89, I thought as I palpated the four quadrants of her abdomen. “You must be a low-mileage model,” I told her. When I pushed on the area over her gall bladder area her eyes flashed in pain, and, sure enough, the CAT scan shows gallstones. The pain soon resolved with IV pain medication, and she was ready to go home but for a small problem; her 92-year-old husband of 70 years still drove but not at night. Friends had to be fetched to fetch her, and while she waited I asked for her secret of staying happily married to a guy for 70 years. “He does the dishes and I laugh at his jokes,” she revealed.

Every night I work in the ER, if I take two seconds to look beyond the disease and the blood and the yuck, I learn something important. But the dishes! Did it have to be the dishes?

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region.