Friday, June 17, 2011

Speaking Frankly

Frank was brought in to the ER with a decreased level of consciousness. (Our technical term is "gorked.") According to the paramedics, he had called 911 and told them he might have had a seizure. (Decreased level of consciousness after a seizure is known as a "post-ictal state. The technical term is, once again, "gorked.")

It was a chaotic night in the ER. I saw 34 patients in the first 7 hours of my shift, and at times one might have to wait over three hours just to get into a room. This may not seem like a long waiting time when compared with a busy urban ER, but around here where people expect both a slower pace and faster service, it becomes a real issue. (For me as a physician, busy times mean more than just an increased workload. Clinically, the pressure to move patients through the system means less time upfront for patient assessment and less time for teaching at the end. Rises in workload also stress the decision-making process and add an extra element of risk to care. Administratively, it also means more patient complaints about delays, which are most often interpreted by hospital administrators as "the doctor's fault." That's not fair, because delays in care are most often related to the system as a whole...not enough beds, too many patients, not enough staff...rather than to the performance of any individual physician. But hospitals are loath to admit that their systems have issues. So the easiest person to blame is the ER doc, who is certainly more disposable than admitting or specialty physicians...translated as those who make money for the hospital...or even nurses who are in short supply. There's always another body with a medical degree out there to take the job, quality beside the point.)

Because there was no room at the inn, Frank got put in the hallway just catty-corner from the nurses’ station. As expected, he was pretty lethargic on arrival. There are two ways to wake somebody up, and they both involve what is politely referred to as "noxious stimuli." The first, and most elemental, is to simply yell at them. So I did.


"Hey, Frank?"


Frank would wake for a moment or two, mumble off a few words, and drift back off to Frankland.

I ordered the requisite labs and studies, and resolved to check on Frank frequently in the next few hours. What I had not realized that my voice had gotten so loud and shrill with my repeated attempts that everyone in the ER now knew there was someone in hallway named Frank and, for some reason, the doctor was very interested in saying "HEY!" to him.

As mentioned, the ER was exceptionally busy. When we get that full, we open up some extra rooms in near the back of the ER that are usually used during the day for chemotherapy and other outpatient work, but can be pressed into service. The way leading back to those rooms went right past where Frank lay asleep in the hallway. So every time I went back there to work with those patients, I took the opportunity to stop by his bedside and shout, "HEY, FRANK!"

This eventually became our collective routine. Every time someone would walk through the back hallway, they would pause for a moment by the bedside and shout, "HEY, FRANK!" This got us to giggling, and soon we were simply looking at each other yelling,"HEY, FRANK!" a behavior that made perfect sense to us but utterly befuddled the poor nurse, not one of our ER clan, called in from home to help with the load. This frantic and frenetic Frankness was noted by a highway patrol officer in the ER at the time, who introduced us to some law enforcement versions of the other kind of noxious stimuli, namely pain. I'm not going to go into detail here other than to say I never thought you could do so much with two toes and an earlobe.

(Speaking of the highway patrol, the officer was here to interview three victims of a motor vehicle accident. They were a family-to-be who was rear-ended on the Interstate. The man was a tall, thin, and pale white with a wide variety of prison tattoos, including the requisite tear drops in the corners of the eyes, skulls surmounted by a flaming cross, and the letters L-O-V-E inked over one set of knuckles with T-R-U-B read over the others. The woman was a heavyset African-American, a good foot and a half shorter and two feet wider than her fiancée, who spent of the evening rocking back and forth in a chair whimpering, "Mama, Mama, Mama." The 15 year old daughter of the woman...the most normal looking and clearly the sanest of them all...also had the worse injuries, with broken teeth and nose. All you could do is look at the three and figure Love is Blind, There's Someone Out There for Everyone or some other simple plaudit because there's really no other way to describe the group.)

Frank did wake up about 4:30 in the morning, and turned out to be a pretty nice guy. He had no idea what had happened to him, only that he recalled having a sandwich delivered from Jimmy John's earlier that night. In a bold show of camaraderie with our patients, we had also received a delivery from Jimmy John's that very evening. It gave us something to talk about, and it turns out that Frank and I both like the Hunter's Club, substituting mustard for mayonnaise. They always say you bond best over food.

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