When you’ve been caring for patients in the emergency department long enough, banter with patients comes naturally. Sometimes the banter becomes a stand-up comedy routine. A child comes in after a car accident and I’ll ask “Were you driving?” If a patient getting stitches asks “Is this going to hurt,” my standard response is “Don’t worry, I won’t feel a thing.”
Occasionally a quick-witted patient will joke back and say something like “Yeah? You’ll feel something if I kick you when you start poking me with that needle.” Those are the patients that you just “click” with. You smile together. You laugh together. Sometimes you even cry together. Those are the patients that can single-handedly raise your spirits from the depths of despair during a miserable shift.
I recall one such patient who was having chest pain and palpitations while watching an episode of “Supernatural.”
“You mean the Supernatural with Sam and Dean Winchester?” I asked. My wife and I used to binge watch that show until it got corny in the later seasons.
“Yeah! Isn’t that show great? Our two sons do a cosplay as Sam and Dean for the convention every year,” the patient replied as she pulled out her phone to show pictures. They were dead ringers for the two main characters.
“Wait. There’s a Supernatural convention!?!” I asked.
“It’s a blast. In fact, God [another character in the show – I told you it got corny] plays in a band there every year and they rock!”
The patient’s husband pulled up the website on his phone and I copied it onto some scrap paper.
“I’m going to surprise my wife with some convention tickets this year.”
Then I turned my attention back to the patient. “Now about that atrial fibrillation you’re in ….”
The patient spontaneously converted to sinus rhythm in the ER and workup was normal. Cardiology recommended treatment with aspirin and a clinic follow up.
“Hope I don’t see you anymore,” I joked. “At least until the Supernatural convention. No more ER visits for you. Got it?”
They both smiled. “OK, Dr. Winchester.”
Then there was another patient. I’ll call her Susan. Susan had a thin stature and a raspy voice from years of smoking. She came to our emergency department for a second opinion, which already rubbed some staff the wrong way. She injured her left forearm at work and was having severe pain. She was seen at another emergency department, diagnosed with a bruise and sent home with a prescription for ibuprofen.
“I really did try taking it,” she said. “It just doesn’t help and the pain is unbearable.”
“It’s OK,” I reassured her. “We’ll get you feeling better. Let’s start with describing how you got hurt.”
Susan’s left arm had been pinched between two rollers in a large machine at work. Her forearm was bruised, but it was also significantly swollen. She couldn’t move her fingers. In fact, passive movement of her fingers caused severe pain in her forearm. I ordered IV morphine.
“I think I know what’s wrong,” I said. “But I’m going to have to stick a needle in your arm to make sure.”
“Whatever you need to do. I trust you.”
The digital screen on the Stryker needle blinked “78.” Damn. Compartment syndrome. I contacted the orthopedist and he called in the OR team.
I went back in the room, sat down and talked with Susan. I explained how I was glad she came in and how she would need emergency surgery. She said that her pain had improved after the morphine. We talked about Susan’s family and about how she likes to bake.
“I’m still going to be able to bake, aren’t I?”
“Wait. Is this one of those jokes like ‘Will I be able to play the piano after surgery – because I couldn’t play it before?’”
We both chuckled.
As she was being rolled off to the operating room I said “OK, now. Hope I don’t see you anymore. At least not in the ER. Supermarket maybe. No more ER visits for you. Deal?”
Fast forward about six weeks. The registration clerk walked back into the emergency department and said that there was a woman here to see me. “She’s actually stopped by a few times this week, but you weren’t here.”
“Uh oh. Does she have a weapon or a manila envelope full of court papers? Never mind. I’ll be up in a minute.”
Susan was standing in the hallway with a big smile on her face. “I made you something.”
She held out a plastic plate with her atrophied left arm. A long scar stretched down the flexor surface of her forearm. The smell of chocolate chip cookies wafted into the air.
“The orthopedist said that I wouldn’t have been able to do this if you hadn’t diagnosed it so quickly. I’ve still got some weakness, but therapy is helping … and I can still bake.”
I thanked her. The smell of fresh baked cookies was starting to garner attention from other staff who were peeking around the corner.
“Oh, and I bought something for you.” She handed me a small flat stone. In the middle of it was inscribed the word “Believe.”
“I just want you to remember that I believe in you because you believed in me.”
Are fresh baked cookie fumes irritating to the eyes? They must be because my eyes suddenly got a little red. I thanked her again and gave her a hug.
“I was going to tell you ‘Hope I don’t see you anymore,’ but you can stop by any time you want with cookies like this.”
Susan’s rock then took its place on the Glory Shelf next to the homemade card from the 7-year-old, the Isabel Bloom Heart in Hand sculpture, and the many other trinkets patients have given me over the years.
During a busy ER shift, another patient registered with a chief complaint of “weakness.” She appeared rather gaunt as the registration clerk accompanied her and her husband down the hall to Room 7. When the patient saw the nurse standing next to me, she waved and smiled.
“Do you know her?” the nurse asked, “because I don’t.”
“Not off the top of my head.” I responded. “I’ll find out.”
It was Susan. I hadn’t seen her in over a year. She had been thin before, but she had lost even more weight since I last saw her.
“I just finished my third round of chemo. I think my counts are low.”
“Wait … what?”
“Metastatic lung cancer,” she said with a half grimace.
As I examined her, she caught me up on her medical history. She was diagnosed with lung cancer when she lost weight. They were trying chemotherapy and radiation treatments. She had been hospitalized before for anemia due to the chemotherapy.
“Are you still baking?” I asked.
“Not much anymore. Kind of lost interest. Don’t have much of an appetite.”
“You know … I still have that stone you gave me. It sits on a shelf right next to my desk at home.”
She smiled and her eyes teared up. “That makes me happy.”
Susan’s counts were acceptable. She felt better after getting some IV fluids and a dose of metoclopramide.
I completed her discharge instructions and went back in the room to wish her well.
It was at that point that I stopped saying “Hope I don’t see you anymore.”
Haven’t said it since.