Night Shift: Street Medicine

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OK everybody, raise your hand if you’ve ever stopped at a car accident to offer/render medical care, helped someone on the street or helped a relative/neighbor with a medical problem.  I’ll bet it’s almost everyone.  Emergency medicine is not just a job or even a specialty.  It’s a genetic condition.  It’s in our DNA to help people.

I like the pay, the flexible hours, the variety, the adrenaline (sometimes) and certainly the challenge.  But when it’s in your blood, you don’t take it off like your lab coat.  It goes with you.  Heck, it’s even contagious.  My wife caught it and she isn’t even medical.

We were driving home from a soccer game at the Naval Academy a few years ago and she noticed a guy sitting on the curb with his bicycle.  He hadn’t wrecked.  He was just sitting there.  And she said, “That guy doesn’t look right.”  I looked over and, dang, if she wasn’t right.  The guy had “that look.”


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I peeled a quick U-turn and walked up to a total stranger and said, “Hi, I’m Dr. Plaster.  Do you feel OK?”

“Actually, I don’t,” he said with obvious relief.

It turned out that he was having chest pain, nausea, sweating and mild shortness of breath.  I took a short history that was pretty unremarkable given that he was a non-smoking, non-diabetic, mildly hypertensive habitual bike rider.  But it was pretty obvious that this guy was having an MI.  My wife had some aspirin, which I gave to him.  We laid him down on the sidewalk and talked about the game while I called 911.  Upon their arrival, they were able to do a 12-lead EKG and we could see that he was having a huge left anterior MI.  While the medics got their lines started and talked to the ER staff I called the hospital operator and asked for the interventional cardiologist on call and reviewed the street findings with him.  So when the ER called he was already alerting the cath lab staff.  It was a 21st century thing of beauty.


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That guy rolled into the ED and up to the lab in minutes and had a stint in his left main before he knew what happened to him.  After the ambulance left, my wife and I just looked at each other with that look of satisfaction.  We both felt like something really, really cool had just happened.  And we had been a part of it.

I saw that guy a year later at a street fair where I sitting outside of a book store signing books.  The guy yelled at me across the street and came running over with his kids.  He gave me a big bear hug and told his kids about how Rebecca and I had saved his life.  Everyone at the street fair saw the scene he created and came up afterward to ask what it was all about.  I just shrugged and said coolly, “I’m an ER doc. I saved his life. You want to buy a book?”

The funny thing about this story is that about half of those who read this story can tell one even better.  It’s not always dramatic though.  Well it’s dramatic to the person or persons involved.  But it’s kind of routine to us.

For instance, one Saturday several summers ago, we had my entire Marine Corps company over to the house for “family day.”  We live on the water so we had kayaks and little sail boats.  People were swimming and just hanging out, while others were cooking hotdogs and drinking sodas.  Well one group was playing bocce when a toddler did what toddlers do and walked just in time for the thing to bean him on the forehead.  The impact split the skin wide open and he began bleeding profusely.


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Being a combat medical unit, no one got particularly bent out of shape, even his mother and father.  They got him settled down. But then we had the question of what to do.

They had all come from the base on a bus.  So if we took him to the ER it was going to be an all afternoon affair, plus a ride back to the base.  They all looked at me and said, “What would you do?  You’re the ER doc?”

I looked at the nice clean lines of the laceration and replied, “I’d super glue it. And get back to the party.”

“Cool,” the parents said in true Marine Corps fashion.  They were particularly amused when I came out of the garage with Gorilla glue.

“He is kind of a little monkey,” the mom said with a relieved chuckle.  A few minutes later, after his glue and band aid, the little guy was back in the swing of things.

But sometimes I can get a little carried away with the front line medicine.  Especially when it comes to my brother-in-law, Bake.  We’ve been bros ever since college when we played basketball together.  We got in so much trouble together that I warned my sister not to date, let alone even think about marrying the guy.  But she didn’t listen to me.

So ever since then she thinks I’ve been trying to kill him.  Like the time I convinced him to jump off a cliff into the ocean.  It was a short cliff.  And even though he didn’t know how to swim, I told him I would be right behind him.  And even if he drowned I would resuscitate him.  The beer helped bolster his courage.

Once we both were in the water, fighting off his flailing arms wasn’t difficult, but it was tough dragging him up onto the rocks.  My sister was screaming and crying and threatening to kill me.  She’s such a drama queen.

So last winter, about this time, they came for their annual New Year’s Eve party at our house.  After a couple drinks started to loosen him up he pulled me aside and confessed that he had noticed having a funny feeling in his chest when he walked up the incline in the parking deck at work.  Now don’t get the wrong impression just because he played collegiate basketball that he is in good shape.  We had a team reunion at my house a few years ago and we all decided to play a pick-up game in the driveway.  Not only could no one dunk any longer, no one could jump off the ground.

The grumbling and groaning had our wives in stitches.  So needless to say, I took him seriously when he said he was having chest pain.  But instead of going to the ER for a workup, I decided to give him a little stress test on the treadmill upstairs in the gym I never use.  And like a fool, he liked the idea.  After all who wants to end a good party so soon?

He didn’t make it 30 seconds on the treadmill.  In fact, had I observed him walking up the stairs I probably would have stopped before we started.  But he covered by stopping several times to take a swig of beer.  “We’re going to run out for a bit,” I told my wife after he recovered from the test.

“I thought they had enough beer,” I heard my wife say to my sister.

“I think we ought to run a few tests on you, and maybe even a stress test,” the ER doc said after hearing his story.

“We already did that,” he said looking over at me with a smirk.

“Have you been drinking?” the ER doc asked.  We both just mumbled ‘No’ with closed mouths and shook our heads.  We were like two naughty boys that got caught having a little fun.  I finally confessed what we had done and how he barely survived.

“I think you need a cath, tonight.” the doc said. I nodded in resigned agreement.

I can still hear my sister’s voice over the phone, “Where are you guys?  It’s been several hours since you left,” she said after finally reaching us.

“First,” I said calmly.  “Everything is good.  The cath went well and his LAD is back to 100% now.”

“What have you done to my husband?” she said through clinched teeth.

“He’s doing fine, but you need to come down to the hospital. He was just having some chest discomfort so we came down to the ER to check it out.”  I held the phone away from my head to preserve my hearing because I knew what my sister would do next.

“How’d she take the news,” Bake asked after I came back into his room.  “She said she was relieved you were in such good hands.”

“Was she talking about you?”

“Nah,” we both said in unison.

 

ABOUT THE AUTHOR

FOUNDER / EXECUTIVE EDITOR Dr. Plaster has been an emergency physician for more than thirty years, working exclusively night shifts for the past twenty years in emergency departments across the country. During that period he joined the U.S. Navy and served two tours in Iraq. Dr. Plaster is the founder and executive editor of Emergency Physicians Monthly and the founder of Plaster Publishing.

1 Comment

  1. Hi Dr Plaster.
    Thank you for the writing. Again. I had such a good laughter reading about your brother-in-law.
    Love your stories! always trying to read them when I have a free minute.

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