Night Shift: Who’s the Patient?

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I enjoy the cultural diversity of the patient population that I serve, but it is not uncommon for me to march into the patient’s room glancing at the chart only to realize that I don’t have a clue how to pronounce the patient’s name. I usually try to make a stab at it, but this night there were so many consonants back to back that I dared not. So I just said my usual cheery “Hello, I’m Dr. Plaster. How can I help you?” But there was just one problem. I didn’t know who “you” was.

The room was full of people who appeared all about the same age as the person whose name was on the chart. Their size and appearance suggested that they were possibly from one of the Vietnamese Hmong groups that had a small enclave of immigrants in the area. After an awkward pause, I finally just blurted out, “Which one of you has burning urine?” They all just looked at me silently with quizzical looks.


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Really? I thought. Nobody speaks English? Then I tried another tack. “Who’s the patient?” I said slowly and reflexively louder than before. “Does anyone speak English?” I finally said in frustration to the blinking group.

“I do,” said a small voice coming from the corner. A tiny child stepped out from behind one of the adults.

Well OK then, I thought. That’s progress.Who’s the patient?” A blank stare. “Who is sick?” She pointed a finger at a woman that looked like her mother sitting quietly in corner. “Well let’s get you on the bed,I said to the woman taking her by the hand and leading her to the bed. Now I saw the hospital gown that she was sitting on.


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“That’s better,” I said under my breath. “I wonder how the triage nurse got the complaint.” I thought about calling the translation line. But I tried that before and found that waiting for someone with very special dialect competency was hard to find. Besides, I thought this looks like a simple problem. I’m sure we can get the basics.

How long has your mama had burning pee pee?” The child seemed to understand and asked the group of adults. The mother was silent, but the adults held a cacophonous conversation with the child for a minute before she responded. “Mama say pee pee hurt for long time.”

“How long?” I said. Another clattering conversation.

“Yesterday,” she said.


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“Let’s just cut to the chase,” I muttered to the scribe. “The UA will tell me the story. I just need to make sure there isn’t something more complicated. Has she had any fever or vomiting?” More committee discussion. Oddly the mother never entered into any of the discussion.

“No,” the little one finally reported. I was beginning to think this was all I was going to get when a young man entered the room somewhat out of breath.

“Sorry, I had to go park the car,” he said in perfect English. I breathed a sigh of relief. My night just got a little simpler.

Soon I was making my way to another room. This time the chart was that of a six-week -old baby. The chief complaint was just “crying.”

As I entered the room I could see the look of fatigue and frustration on the mother’s face as she tried to force a bottle into the screaming baby’s mouth. The infant was dressed in only a thin T-shirt and diaper. And with wildly flailing arms and legs the mother was having a hard time even holding her.

“How long has she been crying like this,” I asked.

“All night,” she said wearily. It was nearing 4 a.m.

“Any vomiting, diarrhea, coughing, fever, skin rash, anything?” I asked. She just shook her head.

As a father of three and grandfather of seven, I had learned a few tricks from experts on the handling of fussy infants. First, listen to your wife. She always told me to warm them up. So I excused myself and got a soft blanket from the warmer. Taking the infant from the exhausted mother I swaddled the baby in the warm blanket and began slow dancing around the room with her in my arms. Almost immediately she quieted down and would take the bottle.

After a few minutes of this, a few firm pats on the diaper followed by a healthy belch, she fell fast asleep. I could see the tension drain from the mother’s face. Now we were able to go over a complete history. Warming my hands and stethoscope, I was even able to get a fairly thorough exam. Though it wasn’t really necessary. There was nothing really wrong with the infant other than a slight change in the weather, from summer heat to a cool thundershower. It felt like a great relief to the adults. But the little one didn’t see it that way. Her little body saw it as an arctic blast.

Just to be safe I thought I would observe the child for a little while, do some re-exams and see if there was something that I might be missing. Returning after an hour, I saw that the infant was sleeping soundly in the mother’s arms. But now I saw the real patient. The mother was sitting bolt upright in a hard chair holding her baby. The look on her face was that same glazed shell-shocked look of exhaustion I had seen on my Marines returning from a long overnight patrol. If her arms hadn’t been locked around the infant she would have dropped her and fallen out of the chair.

“Why don’t you climb up on the bed and take a little nap yourself,” I said. “I’ll get you a pillow and a warm blanket, too. We can put up the bed rails so you can be sure the baby is safe.”

There was a short moment of decision. I could tell she was exhausted and the bed looked inviting. But then she said, “No, I need to get home. I have a 15-month-old.”

“Who’s taking care of the baby now?” I didn’t see a wedding band, but I presumed that since she was alone, there was a father, grandmother or another relative.

“My neighbor,” she said with resignation. I felt so sorry for her. I wished I had suspected something more from the baby so I could keep her under observation longer and give the mom an excuse to sleep. But there really wasn’t anything.

“OK, I’ll write up the home going instructions and let you go.” Even though I was able to calm the baby, I felt like I had failed the real patient.

On my way home after the night shift I got a text from my wife. “Give L a call. He called asking for you. He has a fever. Needs a strep screen and a blood count.”

“What’s up,” I say when I get my son on the phone. “Mom says you have a fever and need a strep screen and a blood count.”

“You’re the board certified emergency physician with 35 years experience,” he said with great wisdom and maturity. “The fever is gone now and I’m feeling better. What do you think?”

“All I have to say is this,” I began as a husband of 44 years. “You may be the one with the symptoms. I may be the doctor with education and experience. But your mother is the patient. Go get your blood tests and we will all feel better.”

“Got it,” he said.

I’ve always thought he was a very smart boy.

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.

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