Of Roaches and Bad Acting

Just before I got off work tonight the triage bell went off. That's a doorbell the admission clerks ring that sounds in the main ER alerting us to a patient in the waiting area. I've heard that same bell in other places out in public and it elicits in me a Pavlovian sense of impending doom.

It is September 11th, 2009, a Friday night and it was 11:45pm, exactly fifteen minutes before my shift ended. This late in one's shift it is perfectly acceptable to ignore the sound of the triage bell, electing instead to stare blankly at the computer screen at a game of Spider Solitaire, letting the other nurses do the work. You're as good as gone, anyway, and nobody really cares. But, because I'm trying really hard to get my full 12 hours in every day I work spurred on by having balanced my checkbook yesterday, I elected to stay long enough to triage the, for me, last patient of the night. I'm kinda glad I didn't miss this one.

I called the patient's name after opening the triage door, prompting a trio of neurologically challenged backwoodsians to stand and begin their painfully slow approach to the triage area among them, an older woman, and a man and younger woman who looked exactly alike. They were like one of those child's games where you take a face and add different hairstyles and glasses, hats, etc to change its appearance but the face never changes. The man carried a metal box which I correctly assumed held the patient's medications. With his other arm, he guided the patient, the younger woman, toward the triage area as if she would collapse and her hand on his arm would somehow prevent that.

ER patients think that their level of perceived acuity is directly related to how slow they walk and talk. It's not unusual to have a patient speak in broken sentances which they mistakenly believe convinces medical personnel of the validity of their ailments. These poor actors, when questioned about their conditions, respond with a breathy, "...can't eat....I'm.....weak...." reminding me of the cartoon series I use to watch on tv when I was a kid. Space Ghost, when stripped of the garments from which he gleaned his superhuman powers would gasp, "....can't.....reach....my....power.....bands....."

The three eventually made it into the triage room and the patient and her mother were seated in the only two seats and I began a brief triage assessment. When I first speak to a patient who presents as this woman did tonight, it's not uncommon for the patient to look at one of the family members, cueing them to begin answering questions for them further illustrating the degree of debilitation they've experienced as a result of their devastating illness. I've even had women tell me a number when I ask their husbands to rate their pain on a scale of 0 to 10. Tonight I dared that family to start answering questions for this woman and, as if they sensed it, they didn't. When I asked her, the patient told me she'd been sick for two weeks.

ER nurses pose seemingly innocent questions to patients which are designed to teach them lessons. My next was one of those questions.

"What happened tonight to bring you to the emergency room?" translates to: "Are you out of your fucking mind? This is an EMERGENCY room. It's called that because you're only suppose to be here if you have an EMERGENCY. Being sick for two weeks does not fall into that catagory. What in the name of all things holy was going through your mind to get your family out at nearly midnight and crawl to town in the middle of the night? What about this date made you decide that today was the day you were finally going to seek medical treatment for something you've been experiencing for two weeks? Is it something about the twin towers? What?"

Turns out, they'd taken the girl to several different clinics and ERs over the two week course of her illness and "nobody would help her". That was my cue to say something like, "Gee, I wonder why everybody is so mean? It's clear to see you've been terribly mistreated. Here honey, you come in our ER. We can see you're sick. You're sick as hell and we're gonna rush you in here and pamper you for as long as you want us to. And if somebody comes in having a heart attack, well, fuck 'em. They can wait while we fluff your pillow." That's what they expect us to say. Really.

I continued my assessment and then did vital signs and documented them and then I looked in the med box. As I was taking one bottle of medication at a time out of the box and writing it on the medication sheet in the chart, I looked down and saw it. A shiny, brown roach crawling amongst the clutter in the bottom of the box. It was about the same time that I decided I had compiled a sufficient list of medications and shut the lid, handing the box back to the male family member, whatever he was; Dad, husband or both.

I then left the room and while the doctor was looking over the chart, I formed a plan. I would tell the man to take the medications out and put them in the car, thereby preventing the escape of the roach into the general population of the ER. When I went back in, I handed the chart to the woman and turned to the man who was, once more, holding the box in one hand and had begun to guide the woman back out into the waiting area with the other.

"If I were you," I said, looking as somber as I could in an attempt to convey some hidden threat of theives, etc, "I'd take those medications out and lock them up in the car."

He remained silent for a second and then said as he turned out the door toward the admissions desk, "I'll just hold onto them. They won't get them away from me."

I clocked out and left before they checked in and came back to a treatment room.