Night Shift: Breaking Guidelines

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“Medic One is inbound to your facility with a 78-year-old male from a local nursing facility. We were called to the scene for a patient with high blood pressure and mental status changes who was being combative with staff …”

The inbound ambulance report was interrupted by a telephone call which happened to be from the patient’s wife.


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“He needs to be evaluated for a stroke. I want him evaluated for a stroke. And I want a priest called in to give him last rites.”

“But ma’am,” the secretary responded, “he hasn’t even arrived yet. We don’t know his condition. It’s Sunday and the priests are performing mass. Besides, the snowstorm has made the roads dangerous to travel. We’re probably not going to be able to find a priest to come in.”

“You need to call around. You’re a Catholic hospital,” the wife said. “And do not admit him or send him back until I get there. I want to see his condition for myself.”


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We knew little about the patient, but suffice it to say that from what we did know, we were not exactly eagerly awaiting the visit from the patient or from the patient’s wife.

Twenty minutes later the squeak of snow-covered boots on the freshly waxed floor signaled the patient’s arrival. His blood pressure was 157/70. Hardly concerning enough for an emergency department visit. As we began to unbundle him from the stretcher, he suddenly developed fire in his eyes and started swinging at the staff. He almost caught one of the paramedics with a right hook to the jaw, but the paramedic turned out of it at the last second so there was hardly any contact. The paramedic winked. “Lucky he telegraphed that one, eh doc?”

We were able to find a priest to come and administer last rites, but when the patient took a swing at a man of the cloth who was anointing him, it was time for a little sedation. While the patient rested we were able to draw blood tests. Despite having a negative stroke scale, we performed a brain CT, which showed no acute changes.

Then the patient’s wife arrived. She was informed of hospital visitor rules. One visitor. Mask at all times. Must stay in patient’s room. She agreed and was brought back to the patient’s room. Yes, we found a priest to administer last rites. No, the CT scan didn’t show a stroke. She pulled the curtains closed.


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The patient received IV fluid while we waited for his lab results. A nurse went to check on him and reminded the patient’s wife of the visitor rules. “Masks must be worn at all times, ma’am.”

When the patient’s labs returned normal, we made plans to return him to the nursing home. Unfortunately, because of the bad weather, no ambulance would be available for several hours. They were all out on other transports.

I went to the patient’s room to update the patient and the wife on his status. The wife had pulled her mask down and was talking to the patient. He was looking at her and smiling.

“Wow. A little different than when he came in,” I said. “ He was swinging quite a bit at people.”

“He has some dementia,” the wife explained. “He used to drive a transport truck during the war and he was attacked many times by people trying to take the supplies, so any time that he’s startled or that he’s in an unfamiliar surrounding he tends to have flashbacks of people attacking him.”

She went to pull her mask back up over her face.

“It’s OK,” I said. “If he’s more comfortable without you wearing it and you’ve had no symptoms, I’m fine with you leaving it off.”

Her eyes began to tear up. “This is the first time that I’ve been able to touch him – the first time I’ve even seen him – since March 7, 2020. We’ve been married for 57 years. You can’t imagine how hard it has been.”

She was right. I couldn’t.

“The nursing home called me, said he had a severe headache, high blood pressure and wasn’t acting right,” she said. “They told me he was having a stroke. I thought I was going to lose him.”

Not quite the report we got from the paramedics or the nursing home. The basis for her phone call became much clearer.

“Well, I have some bad news,” I said. “Everything checked out. His blood pressure is good. He didn’t have a stroke and he’s all set to be discharged back to the nursing home. But because of the bad weather, there aren’t any ambulances available to transport him for several hours. Do you think you’ll be able to stay until they come to get him?”

More tears. She smiled and nodded her head.

Over the next few hours, she fed him lunch. They sat and held each other’s hands. They talked. Every once in a while, a laugh or a loud “HA” would emanate from behind the curtain, which I made sure stayed closed. They talked some more. I could imagine them having the same conversations 57 years ago sitting on a park bench under a tree, lost in each other’s thoughts.

Then the transport crew arrived. As the nurse gave report to the paramedics, the patient’s wife just stood beside him on the stretcher, cupped his face with her hand and repeatedly said, “I love you.”

As they were wheeling him out to the ambulance, I noticed she was holding her phone with her other hand and the screen showed that the phone was on camera mode.

“Did you get a picture with him?” I asked.

“I did get a picture of him.”

“Hold on a second.”

I took her camera and motioned for them to get together. Then I hesitated. I reached over and pulled off both of their masks.

“Oh. It’s on movie mode. Well, tell your wife how much you love her.”

“Yeah,” he said with a wry grin. She laughed and returned the compliment. We switched the phone to camera mode and took a few photos with wide smiles showing genuine happiness. Then the masks went back up and the squeaky boots wheeled the stretcher out to the ambulance bay.

The patient’s wife hugged me and thanked me. I returned the hug and added a smile. “I’m so happy that you were able to spend this time together.”

I kept my negative emotions under wraps, though. For some reason, ER docs seem to be pretty
good at doing that. I’m still not sure if hiding emotions is a blessing or a curse.

I smiled through my guilt knowing that by this point in my career I should know better than to make snap judgments about a situation based upon incomplete information.

I smiled through the underlying emptiness of knowing that those guideline breaking non-socially distanced pictures I took may just be the last time this beautiful couple ever see each other again.

I wonder sometimes whether the cure is worse than the disease.

 

ABOUT THE AUTHOR

SENIOR EDITOR DR. SULLIVAN, an emergency physician and clinical assistant professor at Midwestern University in Illinois, is EPM’s resident legal expert. As a health law attorney, Dr. Sullivan represents medical providers and has published many articles on legal issues in medicine. He is a past president of the Illinois College of Emergency Physicians and a past chair and current member of the American College of Emergency Physicians’ Medical Legal Committee. He can be reached at his legal web site http://sullivanlegal.us.

3 Comments

  1. AJ Howell MD on

    I absolutely LOVE this story! Keep doing what you do, doc! We have to KEEP the humanity in emergency medicine!

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