Author: Neha Verma, UNC SOM
Is There a Word for That?
The eight-year-old patient tells us that before her father hit her, he was smoking something.
“It looked like… it looked like chopped up grass mixed with smashed deodorant,” she says. Blood trickles down the side of her forehead.
As we leave the room and make our way down the hallway, the ED attending and I don’t say anything. Suddenly, he begins to chuckle and breaks the silence with a single word: “Bazooka!”
I look up at him. “What?”
“Is there a word for weed mixed with crack cocaine? I think it might be bazooka, but I can’t remember off the top of my head.”
“I… I’m not sure,” I manage.
“Well, in any case, I liked that little girl’s description much better. Chopped up grass mixed with smashed deodorant. That’s really something, huh?” He chuckles once more.
I’m not sure how to respond, but then I realize I don’t need to. He has already moved on to the next patient.
I hate the ED. I hate that during one of my first shifts, I found my attending chuckling over the word bazooka during a child abuse case. I hate the humor, I hate the cynicism, I hate the rush, I hate the let’s-get-to-the-bottom-of-this-patient’s-bullshit attitude, and I hate trying to learn in the middle of it all.
No surprise, then, that I showed up to my most recent ED shift already looking forward to its end. I fidgeted in my chair as Dr. Smith, the ED attending I had just met, scanned the spreadsheet on his computer screen, deciding which patient he wanted me to go see. Two-hundred-and-eighty-nine minutes to go.
“How about Room 12?” he finally said. “Forty-two year old gentleman. Chief complaint of back pain.”
“Okay.” I walked over to Room 12 and introduced myself to the patient. I listened as the man talked about how he had been in a car accident a few years ago and had had chronic back pain ever since. I nodded while he described his agonizing days and sleepless nights. I wrote down the adverse drug reactions he has to NSAIDs and acetaminophen. I closed my notebook, thanked him for talking with me, and let him know that I’d be back soon with the attending physician.
As I walked back to where Dr. Smith was sitting, my heart sank with every step. I knew how this was going to go. I imagined the slow smirk that would spread across Dr. Smith’s face as I presented the patient. I imagined him shaking his head at my naivety as we discussed a plan. I imagined the condescending lecture he would give me about how this isn’t the kind of thing we waste too much time on in the ED. Two-hundred-and-sixty-eight minutes to go.
I sat down next to Dr. Smith, opened my notebook, and presented the patient. Dr. Smith listened, his face expressionless. When I was finished, he paused for a second, his brow furrowed as though he were deep in thought.
Finally, he spoke: “There are a lot of words for these types of patients in the ED. Frequent fliers and drug seekers, to name a couple. But you know what word I like to use?”
Sure, Dr. Smith, I’ll play your game, I thought as I feigned an interest, smiling wide-eyed and shaking my head.
“Human,” Dr. Smith said.
Author: Kunal Patel
It Starts and Ends with a Joke:
There were heroics last time, the family wasn’t all that happy about it.
There’s a DNR on her, make sure you know that.
They don’t want you controlling the blood pressure, they don’t want meds, transfusions, don’t even think about CPR.
God, I hope I don’t kill her.
Well, it sounds like she or the family wouldn’t mind…
I’m genuinely laughing with the rest of the residents at the surgeon’s comment. We go into the OR, going to remove a malignant tumor. The surgeon is cutting into her skin and I smell the familiar smell of burning flesh. It doesn’t bother me anymore. I almost enjoy it, an odor that signals our entering into another world. Opening our body envelopes, gaining a perspective many don’t see. I suction the smoke coming off the bovie against the fat as I retract the abdomen. The smoke entering into the tubing is my personal gateway into this foreign place within us.
The patient is frail, the skin tears apart at our small tools that are just meant to hold it back. She is bleeding furiously now, I remember the resident telling me we didn’t have the ideal amount of time to get her off her coumadin; the surgeon is working to cauterize as much as she can. We somehow got into the bladder, not being able to pick it out as it hid in the adhesions she had left over from when her uterus was removed years ago. I look to my left as I see the sterile, clear container fill with blood, the red tube connected to my suction device allows her life force to flow away from her body.
The bleeding stopped, we’ve closed the bladder, but I can hear the monitor making unfamiliar beeps. That familiar smell of burning flesh clashes with the vibrations in my ears and I am dumbfounded. Behind the curtain that dehumanizes the abdomen we’re working on, I hear the CRNA say her blood pressure is a bit low, the surgeon keeps working, doing what she can; paying no attention to the voice behind the curtain, and if she’s Dorothy I wonder if I’d rather have courage, heart or brains right now.. They’ve silenced the alarm, the OR is silent again, the river of red is slowly pouring into its basin.
The surgeon steps back a bit as the CRNA says her O2 sat is dropping. I’ve seen this before. The CRNA that time was working fast, the anesthesiologist was there and I was looking over his shoulder as he did a bronchoscopy to help that patient. I’m standing still. There’s an electricity in my body, I become aware of the tile floor I’m standing on for the first time, and recognize how it supports me up. The alien place within me feels like it’ll burst this body envelope with or without burning flesh. I’m thinking about yesterday, just yesterday, when I had more training on emergent life-threatening situations. I want to feel for a pulse, check the breathing, yell their name. I ground myself onto the tile floor keeping myself from doing anything I want to.
I’m taking my gown and gloves off, walk outside as I remove my facemask. I’m walking behind the surgeon and resident, I don’t know if they’re saying anything. I tell myself that it’s alright, this is fine. We talked about it, we joked about it, this wasn’t unexpected, her quality of life wasn’t worth it. We joked about it. The patient and the family were upset when their first DNR wasn’t honored, we’re putting patient care first. We joked about it. I’m going through the whole conversation we had before this. It had ended with me laughing. I make eye contact with my resident, she raises her eyebrows and lets out a deep sigh. She asks what I’m thinking. I tell her I’m a bit shocked, but I’m ok. She gives me a sincere look and I’m half listening as I think she tells me how this isn’t fun, and it won’t be ok, but we did good to respect the patient. I’m only half listening. The punchline’s laughter crowding my mind.