Speaking Their Language

On another night in the Jail Ward ER, local PD drunk driver task force delivers to us Mr. Jose Jimenez, their latest catch. He's pretty harmless-looking, despite the official escort, and while a bit groggy, is soft-spoken and quiet, with a Central Casting voice that sounds close enough to Bill Dana's Astronaut Jose Jimenez that I have to stifle a giggle.

They need him to get checked out and medically cleared, so they can book him for DUI, evading arrest, etc. etc.

Seems that they observed him weaving, hit the flashing lights, he floored it, and in his haste to escape, crashed into half a dozen cars. So they pulled him out, noted his slurred speech, absence of alertness, and generally out-of-touch demeanor, hooked him up, and brought him to us for the once-over before getting him a bunk at the jailhouse. Another drunk off the road.

So they help him wobble into our mini-ER, pour him into a handy chair, and we began getting his info, checking him over, and such.

And my Spanish, far from flawless, is passable. I paid attention to four years in high school enough to get As the whole time. Which was great for passing tests, learning vocabulary, grammar, and syntax, but about worthless for holding an actual conversation. Two years in Hell, with native fluent Spanish-speaking staff, however, has given me all the medical vocabulary I never had, and a few thousand pacientes to practice on. So I figure I'm about a fourth-grader in my espanol, which ain't bad for a white kid, especially compared to the Californicated hispanic staff members born here whose only Spanish is "Taco Bell" and "margarita".

So between me and the doc in the jail ER, it transpires in our interview that Jose claims to have had no alcohol. Which screws up the math. Normally, you have to use the metric conversion, because anyone who admits to having had 2 beers, really had 36 beers. You arrive at this truth by doubling the reported number and adding 32, the same way you roughly convert Celsius to Farenheit. Countless blood alcohol level tests have shown my math to be a far more accurate system than simply relying on the truthful recollection of those who imbibe.

Further exploration of Jose's history reveals that he does, in fact, have the diabetes, and is not a bad diabetic, defined in my lexicon as one who sometimes forgets to take the meds, never forgets to have a meal, and always has dessert;but is rather more of a mediocre diabetic, in that he always remembers his insulin, but sometimes forgets minor details like, say, dinner. As happened tonight.

So putting a hold on other things, I grab a quick Accucheck of his blood sugar. Which, in the event, winds up being 22. It is "kind of low" only if you'd refer to a 747's wheels a few feet over your rooftop in the same manner. Jose's about to crash. Actually, already did, if we're counting cars.

So after getting some orange juice in Jose's hand, and then an IV, and then a couple of amps of D50 going in with some D5W, we get him tucked into a nice gurney, and doc calls the admitting resident about a reservation for a party of one.

After getting things settled a bit, I wander out for a little update with Jose's escorts, to update them on the possibility that his accomodations plans will likely be a little different than they'd planned.

"But he looked right at us, and took off the second we hit the flashing lights!" protests one of the officers, sure as anything he'd nailed an actual drunk and racked up another stat.

"Well," says I, "I went to nursing school, not the police academy or law school, but unless there's a radical change in things, I don't think you'll be getting him for DUI. I'm betting his insurance is going to be liable for those cars he hit, and I'm absolutely happy you got him off the roads tonight, but he's probably not drunk based on what we're seeing. But if it makes you feel any better, besides the lives of anyone he might have hit, you absolutely saved the guy's life, because he's about a half an inch from going to sleep and not waking up. Ever. And if he'd just been put in a holding cell, and checked on in the morning, this'da been a coroner's case. Glad you brought him. Maybe you can tell that to his family, in case they're any kind of pissed that he got busted tonight. Jose really owes you guys big time."

"And, much as using anything but English annoys me, and probably you, you might want to brush up, just a little, on your Spanish. It couldn't hurt."

"Probably not. Saved his life, huh? Thanks for the info. Really, thanks. What's the plan for him?"

"I'm pretty sure the doc's making arrangements to keep him here tonight. Which beats me finding him on the roads when I drive home, or you finding him cold and dead at the end of shift. Nice going. The doc or I'd be happy to tell your sergeant, if you want."

See, you just have to know how to talk to people.

The Towering Inferno

The ER at the Seventh Circle Of Hell Hospital is state-of-the-art 80 years ago architecture, with 5 seconds ago state of the art practitioners.

But some - okay way too many - of our visitors are simply Neanderthal @$$holes.

So some small number of months into my then budding career, Doctor Captain Kirk is the designated King of the Plebes, the most experienced 4th year resident non-board-certified ER MD in charge of various less-experienced docs.

Shortly after start of another glorious night shift in Fun City, paramedics deliver unto us Mr. Prince. His royal lineage is apparent, as he's wearing the Royal Gold Robe of Backboard, and the Most Excellent Mantle Of The C-Collar. And given his absolutely blueblood pedigree, in this case, probably mostly either Johhny Walker Blue blood, or perhaps Bombay Sapphire blue blood, but in any event, definitely 86-proof, he deigns to speak to us lesser mortals in the universal language of our local royalty, by greeting all and sundry doctors and nurses as "motherf*****s."

Then, in case we don't understand his meaning, he switches back and forth from English to Spanish to Drunkish, but peppered with frequent and liberal sprinklings of F and MF bombs, which, in a curious linguistic trait worthy of neurological and psychological investigation, is the only word of English the Egregiously Polluted Drunkaholic ESL student can retain with flawless presentation and enunciation, in 100% of documented cases.

Whereupon, Doctor Captain Kirk dons his cape and goes to work.

He's already at the head of the bed, ready to do his baseline exam on Mr. Prince, with a view to clearing his C-spine, etc. just like the last 5,000 traumas he's done in 3 1/2 years of residency. But Mr. Prince is apparently the Official 1,000,000th F-Bomber, and has just won Doctor Captain Kirk's Special Attention, delivered thusly:

Doctor Captain Kirk, no tiny man he, leans over the patients head and shoulders, grasps the C-collar firmly with both open hands, and from about 8 inches above Mr. Prince's face, gives him THE WORD.

"SHUT.THE.F###.UP.@$$HOLE!
I've taken care of you drunk @$$holes for 4 years, and I've had enough of your stupid $#!^. You may be hurt, and we're going to help you. But what we're not going to do is listen to your drunken ranting, or tolerate your filthy backtalk for one more minute. So just lay there, answer my questions, let us do our jobs, and
STOP."MOTHERF###ING".ME!,
STOP."MOTHERF###ING".MY.NURSES!
AND.STOP.MOTHERF###ING.TALKING!
Until you can act like a goddamned human being, don't say another word. We're busy, and we don't have time for another minute of your obnoxious shit.
We're all sick of it. So just shut it.You got that??"

Whereafter Mr. Prince squeaked out the most contrite, humble, and nigh inaudible
"Yes" ever uttered, and proceeded to conspicuously shut up and let us get to work.

I know this because Seventh Circle Of Hell Hospital has no doors, just curtains for each cubicle, so from every corner of the ER, Doctor Captain Kirk's Straw-That-Broke-The-Camel's-Back monologue has echoed off the walls, and swear to Buddha, I can hear the fists of 20 nurses throughout the department pumping skyward, as they're all telepathically screaming "YEEEESSSSS! YEEEESSSS! YEEEEEEESSSSSSS!!!!!!! and doing the ER Happy Dance right on the spot.

One of my co-workers turns to me and confesses, "I've been wanting to give that speech for 4 months."

Only the absolutely typical way-too-soul-crushingly-busy patient load, and state laws against vandalism, prevent us from gang-rushing Doctor Captain Kirk, carrying him around the ER on our shoulders, and having his face graven in the stone walls of the hospital entry beside the statues of Galen and Hippocrates.

Best. Bedside. Manner. Ever.

The Education Of Doctor Bambi

Not being a girl, and thus expendable in the taxonomy of the charge nurse du nuit, I'm rather uncomplainingly floated to cover the jail ward with one of the ER docs in training.
The potential's always there for danger, but it really isn't that bad, because the inmates are usually hoping to stay, for better food and less chance of getting knifed, plus cable TV. Acting up would interfere, so they're usually model citizens in our house, right in the middle of 2 dozen deputies, and random transient police from a dozen agencies bringing in the folks we need to screen before they can be booked, or admit them because they're too jacked up to go to jail.

So after being buzzed into Mordor, and given the 5 cent tour, we settle in to see if the night will bring us business, or a chance to catch up on our reading.

Around 11 PM we get our answer, as deputies deposit on our doorstep an unfortunate lad with a face looking something like steak and eggplant casserole.

So after I get vitals, Doctor Bambi ascertains from our somewhat the worse for wear patient that the mechanism of injury was falling out of his bunk.

Physical exam and x-rays determine all of his teeth are intact, he has a skull of iron, flawlessly uncracked anywhere, but apparently poor luck with the laws of gravity, in this case, the gravity of standing too close to someone who didn't like him.

Doctor Bambi sends him back, with an order for the nurse actually at the jail to give him Tylenol for pain as needed, and we hand him back to the gentle care of the county's custodians of the criminally stupid.

Then Doctor Bambi pops up, and asks where the sherrif's officer in charge has his office.

"What for, doc?" I inquire.

"Because," says she, "that's the 5th patient this month I've had who fell out of his bunk. I'm going to let them know that they need to do something about that, put up safety rails, or something. This is just unacceptable, even if they're criminals."

"Uh, Doc, how long have you done Jail Ward?"

"I didn't do any last year, this is my 3rd rotation this year."

"So, just the two shifts, total, besides tonight...?"

"Yeah." Then, "Why do you ask?"

"Doc, NONE of those patients "fell out of their bunk". They pissed off someone bigger, badder, or different colored, or all three, maybe even a gang of them, and so they got their @$$%$ kicked. And they're stupid, but smart enough to know if they rat somebody out, their next run-in might be toothbrush poisoning, when someone stabs them for snitching. So they "fall down" a lot, from the bunks, in the showers, whatever.

Just as a 150-watt bulb snaps on 6 inches over her head, Doctor Bambi does a facepalm, and says "I am so NAIVE! Dohhh!"

So about 1 AM, we get another case of Malignant Bed Syndrome, this one with both a fractured cheekbone, 2 cracked ribs, and a beautiful imprint of a popular shoe as plain as a tattoo right in the middle of his upper back.

Mechanism of Injury: Fell out of bunk.

So, along with a scrip for some Tylenol with codeine for pain, Doc gives him a classic sendoff as I'm getting the papers for our latest winner of the Victim Lottery ready to roll back to his new temporary home with his custodians:
"Mr. Perp, I understand you had a tragic fall from your sleeping area tonight. I don't know what might have caused this unfortunate problem, but as a doctor, I'd advise you to stay away from that bunk, and any of that bunk's friends, unless you can sort out whatever's causing you to fall out of it, because if you keep falling out of that particular bunk, the next time you're liable to end up in the ICU with internal injuries. You understand me?"

I stiffle a snort. Looks like Doctor Bambi's growing some antlers tonight.

Not A&O, But At Least His Priorities Are Straight

College kid, suffering brief loss of consciousness after broomstick to head during broomball game at local ice rink, comes around within about a minute.

Witnessed questions first asked by patient immediately after regaining consciousness:
"Who am I, and who am I dating?"

Diagnosis Of The Week

Nigh on Impossible Stick and IDDM diabetic patient (and family entourage) on their 3rd visit in 7 days, and their 15th in 3 weeks time.

Pt. totally out of it, with a blood sugar reading of 1246 on initial lab draw.

After yet another half-night's being carefully flown down to the mid-300s, and yet another overnight ICU admit, pt. candidly admits to doing level best to kill most of half a gallon of delicious mint-chocolate chip ice cream that day.

While the initial urge to call this Sugar Suicide is a good choice, sober reflection will correctly diagnose this condition as
Low Grey Matter Titer.

And my state's Health and Welfare and Penal Codes notwithstanding, I'm firmly of the opinion that a diabetic eating a tub of ice cream meets the textbook legal definition of Informed Consent For Therapeutic Headslapping, (normally an independent intervention, but also backed up resolutely by the ER doc, as usual) and a serious argument for having granted Power Of Attorney to do the same to the rest of the Tard Family, for watching these proceedings from lunchtime to ICU, inclusive.

That scene in Harry Potter: Goblet Of Fire, where the dragon spews fire at the rock he's cowering behind is what I'm calling tonight's "patient education" portion of my nursing interventions for this patient. And if I can find a brochure for the local mortuary to hand them for the inevitable funeral planning, while everyone in the room is alert, conscious, and breathing, it should be the cherry on their cake. (You should forgive the pun.)