Angels in the ER (28 page)

“Thanks. I’ll give you a call if something changes.”

As I hung up the phone, Lori asked me, “Did he have anything to offer? Any ideas?”

“No, nothing,” I said. “Just pretty much what we already know. Stewart’s not doing well, and I don’t know if he is going to survive the evening. I need to go talk with them.”

One of our techs was adjusting Stewart’s monitor as I entered the room.

“Sandy,” I said to her. “I need to talk with the Donaldsons, if you wouldn’t mind stepping out for a minute.”

She finished adjusting the leads and checked the rate of the IV fluids. “Sure,” she said. “I’ll be right outside.”

She closed the door behind her and I was alone with the couple.

Maggie was standing by the head of the stretcher and was gently stroking Stewart’s hair. He was still struggling for breath, though not quite as badly now. He was able to talk but not in long stretches.

“Well, Doctor, what does it look like?” he asked.

I pulled a stool over and sat down by his side, his chart in my lap.

“Pretty much what we thought, Stewart,” I said to him. “And probably what the two of you thought. It looks like you’ve had another heart attack and it’s tipped you over into congestive failure.”

“Hmm,” he mused. “We’ve been here before.” He paused and caught his breath. “But this seems a little worse somehow.”

Maggie stopped caressing her husband’s head and said, “Dr. Lesslie, how bad is it? What do you really think?”

I glanced over at his monitor and noted that his heart rate had slowed a little, but it continued to struggle along in the 110-to-120-per-minute range. Still not good.

Looking at Maggie and then at Stewart, I told them, “You know, how bad it is really doesn’t matter. Your blood work shows you’ve had more heart muscle damage, and we all know you didn’t have much if any to spare. Any further heart tissue loss would be…would put you—”

“Am I going to die?” Stewart asked straight up. He was calm as he said this, and Maggie didn’t flinch. I knew I needed to be honest with them and tell them what I thought and felt.

Still, it was difficult. I cleared my voice before beginning.

“Stewart, I don’t think your heart can take much more. We’ve run out of options here to help you, and I…I think it’s just a matter of time. Maybe not much time.”

He didn’t say anything but just raised his left hand in the air and Maggie reached down and grasped it. She was nodding her head and I saw that her eyes glistened, but there were no tears.

“Okay,” he said with a new and surprising firmness in his voice. “Where do we go from here? We really don’t want to be admitted to the hospital.”

While he was catching his breath Maggie said, “How much time do you think we have? A day? Maybe two?”

I shook my head and said, “No, not a day. Maybe a few hours, or even less.” It was difficult to say these words, but it was true. And they needed to know.

When she heard this, she took her husband’s hand in both of hers
and they looked at each other. He slowly nodded his head, wordlessly telling her that I was right.

For a moment the three of us remained silent. Then I stood up and walked to the edge of the bed.

“Let’s do this,” I began. “Stewart, I’m going to keep you here in the department for as long as I can. No, I’ll keep you here in the department, period. And Maggie, you stay here with him. I’m going to have a more comfortable chair brought in for you, and if you need anything else, we’ll be right outside the door. No one will bother you.”

They looked at each other again and then at me.

Maggie spoke. “Thank you, Dr. Lesslie. We appreciate…” Her voice cracked, and I knew I had to leave the room. I turned away and walked to the door.

“Thank you, Dr. Lesslie,” she said again.

Stewart and Maggie spent the next hour and twenty minutes together, talking and holding hands. They said the things they needed and wanted to say to each other, and then as Stewart’s breathing became more labored, they fell silent.

Shortly after that, his monitor fell silent and Stewart was gone.

Later, after Maggie had gone home and the department had shifted into its usual evening rush of activity, I found myself walking up the hallway with three clipboards under my arms. There were new auto accident victims in minor trauma, nothing serious, just a few bumps and bruises. As I neared the nurses’ station, a flash of color caught my eye and I stopped.

On the countertop was Maggie’s rose.

 13 

You’re
on My Last
Nerve

A man’s wisdom gives him patience; it is to
his glory to overlook an offense.

—
P
ROVERBS 19:11

I
n the ER, if you have not mastered the skill of patience, you subject yourself to the risk of making unnecessary mistakes, distressing and disappointing those who look to you as a leader, and feeling pretty crummy at the end of your shift.

You feel crummy because some person or some situation has gotten the better of you. In the ER we are frequently tested in this area, and the testing usually comes in the form of an ER abuser
.
We need to make the distinction here between an “ER regular” and an “ER abuser.” You have already met some of our “regulars,” such as Slim Brantley. Slim means no harm and his ultimate motivation for coming to the ER is for food, warmth, and companionship.

An abuser, on the other hand, is frequently driven by sinister purposes. These purposes usually involve obtaining an injection of a potent pain medication, or even more desirable, the writing of a prescription for the same. The realization of these goals is achieved through deceit, deception, and sometimes violence.

Dealing with these individuals requires a large measure of patience and a diminished view of the importance of “self.” These interactions are not contests between the ER doctor and a drug seeker. There is no moral or righteous high ground on which to plant our banner. There are no winners here—only the potential for all involved to be losers.

This was a difficult lesson for me to learn. I was amazed, as an
intern, by the tenacity of these individuals, and by their audacity. My hackles went up when a “seeker” presented himself or herself to the department, and I believed it was my sworn and sacred duty to uncover and thwart their crafty and cunning efforts. I would not be bested.

11:55 p.m.
I was at the nurses’ station, contemplating the stack of charts of patients who were awaiting my attention. The double-cover doctor had left at eleven, leaving me with five or six people to take care of. Thankfully they all had seemingly trivial problems.

“Why don’t you get this place cleaned out,” Trish, our unit secretary said to me. She smiled, leaned back in her chair, and put her hands behind her head. “One of the nurses from 3North is going out for pizza and said she’ll pick us up something if we want.”

I was finishing up the record of a kid with strep throat and glanced again at the unseen stack of charts.

“Shouldn’t take too long,” I answered, unbothered by her gentle chiding. “Why don’t you go ahead and get something organized. See what everyone wants.”

After placing the kid’s chart in the discharge rack, I picked up the record of the next patient to be seen. Room 3A: “Cough and can’t sleep.”

As I turned toward the door of room 3, my attention was drawn to the triage entrance. Jeff was leading a young man into the department. He was making a note on the patient’s chart, and when he briefly looked up, his eyes caught mine. He lowered his head just a little and raised his eyebrows. This signal, unseen by the patient behind him, told me something was up.

The twentysomething man was dressed in jeans and a T-shirt that advertised “MYRTLE BEACH.” His flip-flops slapped the tiled floor as he was led to room 4. Under his arm he carried a smudged and worn X-ray folder.

I turned toward my coughing and sleep-deprived patient. I was curious about our new visitor in room 4, but he would have to wait his turn.

It was almost 1:30 in the morning, and the stack of charts on the counter had been reduced to just one, that of the patient in room 4. I had not had a chance to talk with Jeff about this guy, and right now Jeff was back out in triage.

I picked up the chart and looked at the chief complaint. “Right leg pain. History of bone cancer.”

Hmm. That was a little unusual.

His vital signs were normal. No fever and no elevated heart rate. A rapid heartbeat can be a reasonably good indicator of significant pain and stress. There was nothing else on the chart of any particular interest, except that he listed a city in Florida as his residence. Then I noticed that the ER business office had handwritten “No picture ID” on the bottom of his personal information sheet. This was beginning to smell a little peculiar, and instinctively my defenses were on alert.

Pulling the curtain aside, I stepped into his room. John Glover was sitting on the stretcher, his legs dangling over the side. He looked up as I entered and immediately began rubbing his right thigh.

“Hey, Doc. I hope you can help me,” he implored.

I stepped across the room and sat down in the chair opposite his stretcher.

“I’m Dr. Lesslie,” I introduced myself. “What can we do for you tonight?”

He continued to rub his thigh and looked down at this apparently painful appendage. “It’s this leg, Doc. About eight months ago I started having some pain right here,” he began, pointing to the mid-front of his thigh. “Not bad at first, but it just kept on hurting. After a few weeks I couldn’t stand it any longer and I went to see a doctor.”

At this point he stopped rubbing his thigh long enough to pat the X-ray folder lying beside him on the stretcher. “They got some X-rays
and gave me some awful news. I’ve got bone cancer, and they say it’s pretty bad.”

He put his head in his hands and shook it from side to side. I was impressed.

“I’m on my way to see my sister in Virginia and I ran out of pain medicine. I just need enough for about two weeks. And if I make it that long, I’ll be back home in Florida and can see my own doctor.”

I was about to ask something when he spoke again. “Oh, and when it gets this bad, they usually give me a shot of Demerol and either Tylox or Percocet. That’s what usually helps.”