Angels in the ER (14 page)

Her jaw had been shattered by Johnny’s punch.

An operation would repair the fractured bone, but that blow could never be taken back. It would be a part of this family, of this relationship, forever.

Later, at the nurses’ station, I looked up from the clipboard of room 2 and put down my pen. I stared at the closed curtain across from me. I had just remembered something. Next Sunday would be Mother’s Day.

It was 10:30 on a Friday evening. Sometime between six o’clock and midnight usually marks the official beginning of the weekend. Our volume will pick up, and the nature of our patient encounters begins to change. It’s not a coincidence that this time of the week marks the beginning of an increase in alcohol consumption. More wrecks, more falls, more fistfights. Everybody seems to be having a big time.

This particular overnight shift had thus far proven to be typical. We had already had a knifing and a moped accident. The knifing was a superficial laceration of a young man’s buttocks, inflicted as he attempted to escape the grasp of an acquaintance he had just whacked over the head with a beer bottle. The moped accident was more interesting. Three large individuals had attempted to ride this small conveyance at the same time, convinced they would be able to jump a low rock wall on the edge of a field. Gravity had reared its ugly head, and I would have a few of theirs to suture. Nothing serious.

Jeff and I were standing at the nurses’ station talking about this daredevil trio, when the automatic ambulance doors hissed open, announcing the arrival of new business. We both looked up to see one of our EMS units wheeling two stretchers into the department.

Denton Roberts was guiding the first gurney into the ER, and he stopped adjacent to where we stood. On the stretcher was a thirty-year-old woman, awake and looking around. Her face was pale, her expression anxious, and there were a number of abrasions on her forehead. Pieces of glass were scattered through her long blonde hair.

“What happened here?” I asked Denton, reflexively taking her wrist and checking her pulse. It was a little fast, but strong and regular. An IV had been inserted into the back of her other hand and was connected to a bag of saline that hung from a pole at the head of the stretcher. I could see it was flowing wide open.

“Auto accident out on Highway 5,” he answered. He nodded behind him at the following stretcher. “The guy there was driving. Both of them have had a little too much to drink. Actually, he’s pretty soused and he went off the road, into a ditch. She’s complaining of belly pain and he has some back pain. Both of their vital signs are okay.
No loss of consciousness. She was still seat-belted in the car. When we got there, he was walking around in the middle of the road. Put ’em both in full spinal protocol and started IVs. He looks all right, but you’re gonna have fun,” he finished, with a wry smile.

“What do you mean?” I looked in the direction of our second victim.

“Well, let’s just say he’s not a happy camper,” Denton added, nodding.

If I had any doubt as to his meaning, I was quickly enlightened. “Full spinal protocol” meant that a person would be strapped down on a rigid backboard, arms by their sides, legs straight out, and head and neck strapped in place, allowing no movement. This was necessary to protect someone with obvious or potential spinal injuries. But it was also very uncomfortable.

“Get me off this thing!”

Sandy Green, Denton’s partner, was struggling with our next guest. Sandy was trying to guide the stretcher into the department with one hand and attempting to keep the patient from falling off with the other.

“And get this thing out of my arm!” He was referring to the IV that had been placed in his right elbow, which he was clumsily attempting to grasp. Sandy needed another hand, maybe two.

“Jimmy, you be still and let them help you.” The calm and plaintive admonition came from the young woman in front of me.

“I don’ need no help! I need to get outta here!”

Jeff had already moved toward the second stretcher and was trying to help Sandy maintain order.

“Hold on a minute, Jimmy,” he instructed him. “Let us just get you to a bed and check you over, and then you can get out of here, okay?”

“I don’ need to be checked over! Just lemme get up from here!” was the response.

I looked up at Denton. “Take them back to minor trauma. A and B. I don’t think there’s anyone in there right now.”

“Okay, Doc,” he answered, and he started down the hall with his patient.

As Sandy came by the nurses’ station, I patted him on the shoulder. He was a large man, and he was sweating profusely. “Just follow Denton,” I told him.

He nodded without saying a word.

I glanced down at his patient. He was probably in his early thirties, dressed in blue jeans and a T-shirt, and he had on running shoes. His long jet-black hair looked dyed and was unkempt. On his right forearm was a large tattoo. The name “Amanda” was emblazoned in black ink over a large red heart. Other than this tattoo, I didn’t see a mark on him—no scratch, no blood. Nothing.

“Sheryl!” he called out. “Where they takin’ you?”

Sheryl?
I glanced again at the tattoo. Hmm. Love is a fickle thing.

“Just relax, Jimmy.” Sandy tried to calm him. “We’re going with her. Just hold on.”

They moved off down the hallway, with Jimmy eloquently expressing his displeasure with the current circumstances.

“I told you to get me off this thing!”

While I finished up with two other patients, Jeff made an assessment of our auto accident victims. He walked up to the counter with their charts in his hands.

“Finally got Jimmy calmed down,” he told me. “I don’t know how long he’ll stay that way, though. He’s pretty drunk. And pretty obnoxious. He’s on bed A. Looks okay, just complainin’ of low back pain. But he’s movin’ around pretty good.”

I finished up the chart I was working on and put it into the “Discharge” basket. “Good. And what about her?”

“I don’t know. I think she’s got somethin’ goin’ on,” Jeff said. “Heart rate’s about 110, and her belly is tender. Blood pressure is 110 over 70. Everything else seems okay. I upped her IV.”

“Good,” I responded. “I’ll go take a look.”

I had worked with Jeff long enough to know that when he thought something was going on, it usually was. He didn’t overreact, and he’d seen a bunch.

Tammy, one of our evening nurse techs, was in minor trauma with our two patients. They were on adjacent beds with a curtain separating them. Jimmy was lying quietly for the moment, his eyes closed. I walked over to bed B.

“How are you feeling, Sheryl?” I asked.

She looked up at me. “Not too good, Doc. What’s wrong with me?”

“We’re going to find out,” I told her, as I gently began to palpate her abdomen. Jeff was right. It was tender and was becoming distended.

“Does this hurt over here?” I asked, pushing down on her left upper belly, just below the rib cage. The spleen lives here, and I was suspicious it might have been injured in the accident. If it was ruptured and bleeding, that might account for the distension.

“Ooh! Yes! That hurts!” she cried out, but still remained calm.

I stopped pressing and took my hands off.

“Okay, we won’t do that again,” I told her. “But it looks like you might have injured something in your abdomen, maybe your spleen, so we’re going to get a CT scan as fast as we can. I’m also going to have one of our surgeons take a look at you.”

“Is it bad, Doctor?” she asked.

“Well, it depends on what we find,” I answered. “But we’ll get it fixed, whatever it is. Okay?”

“Okay,” she sighed, and closed her eyes.

Before I turned to leave I asked, “Oh, and one other thing. Have you had anything to drink tonight?”

I could smell alcohol on her breath, but she didn’t appear to be intoxicated.

She didn’t hesitate with her answer. “Just one beer. That’s all.”

I made a note on the chart, believing her. The usual response in the ER to this question is “Two beers, Doc.” It doesn’t matter how smashed
a person appears, it’s always “two beers.” I suppose the honesty switch gets turned off when your blood alcohol reaches a certain level.

Moving to bed A, I made a quick assessment of her partner. He was snoring now, and he barely opened his eyes as I examined him. His vital signs were completely normal and I could find no evidence of any significant injury.

I did manage to rouse him enough to ask a question. “How much have you had to drink tonight, Jimmy?”

“Two beers,” was the slurred response. I didn’t write that down.

At the nurses’ station I asked the unit secretary to see if Tom Daniels was in the hospital. He was the surgeon on call tonight, and if he was around, I wanted to catch him before he went home.

A few minutes later she picked up the phone, then covered the mouthpiece and said, “Dr. Daniels is in the OR, finishing up a case. Do you need to talk with him? It’s the OR supervisor.”

“No,” I told her. “Just ask him to stop by the ER when he’s finished. Tell him I might have a spleen for him.”

She relayed the message and hung up. “He should be here in about ten minutes,” she told me.

They were ready for Sheryl in CT, but ten more minutes wouldn’t make much difference. We could wait.

“Jeff, Jimmy in minor trauma will need a urine,” I instructed him. “Just check for blood. We’ll make sure he didn’t injure his kidneys and then he should be able to go.”

“Sure,” he answered. “But he’ll have to use a urinal. I don’t think he can walk.”

“You’re right,” I said. “Good luck with that. You may not even be able to wake him up.”

Jeff went into the supply room and came out with one of our stainless steel urinals. He walked down the hall toward minor trauma, and I was a few steps behind him.

I was about to turn into the four-bed room when I caught sight of Tom Daniels coming around the corner in the back of the department. He still had on his surgical scrubs and cap.

“Long night?” I asked him.

“Long day,” was his response. “It’s been nonstop. The OR said you might have something for me. A possible spleen?”

“Yeah, she’s right in here.”

I led him into minor trauma and noticed Jeff trying to rouse our somnolent patient in bed A. We moved past that bed and behind the curtain separating him from bed B.

“Sheryl, this is Dr. Daniels,” I said to her. “He’s the surgeon on call tonight, and I wanted him to take a look at you.”

Tom walked over to the side of the stretcher. “Sheryl, is it? I’m Tom Daniels. Dr. Lesslie tells me you’ve been having a pretty rough night.”

He proceeded to examine her, asking questions as he proceeded. As he palpated her abdomen she moaned and shifted herself on the bed. He looked up at me and nodded.

“Sheryl, I agree with Dr. Lesslie. Something’s going on inside your belly and we’re probably going to need to go to the operating room to find out what that is. We’ll get the CT scan first, and then decide on a plan. Okay?”

“Okay, Doctor,” she answered. “I just want to stop hurting.”

As she was saying these last words, I heard some grunting from behind me on the other side of the curtain. I had been aware of some unusual noises behind us, but this was louder and more ominous. Then, “Ooh! Enough!”

Then more grunting and the sounds of a struggle. Suddenly, the urinal flew across the room, clanging loudly against the ceiling light over bed C, then the IV pole in the corner, and finally the floor. It spun around a few times and came to a stop.

Jeff had been trying to get a urine specimen from Jimmy, and Jimmy was not being compliant. When he had first been roused from his alcoholic slumber, he had struck out with a fist, catching Jeff cleanly on the left ear. Then he’d kicked him twice, once in the stomach and once on his thigh. The final straw came when he grabbed Jeff’s forearm and drew blood with his fingernails.

Tom Daniels looked at me. I turned, pulling back the curtain.

The grunting was coming from Jimmy, and for good reason. For a moment I watched, mesmerized. Jimmy was still flat on his back on the bed. But Jeff was straddling him, his big left hand pressing down on his chest. Every minute or so, Jimmy would squirm and struggle and try to kick him.