The following are some random vignettes to give you, the reader, a peek beyond the curtain of healing, disease and medical care that made County different from other hospitals.
Given the size of the program and the lack of formal orientation, it took a while for all the new house staff to get to know each other. This is a crucial point in the following story.
We received a call that a red blanket admission was coming to the floor. When the gurney came off the elevator, it contained a young man thrashing about, trying to get out of the hard restraints that kept his arms tied down. He was severely agitated, screaming that he needed to be released immediately. His eyes were blood shot; he clearly hadn’t had a bath or a shave in the past 1-2 days, and appeared to be confused. The admitting sheet from the ER said, “Awake OD (over dose); patient confused, thinks he’s an MD.” We were trying to get him to quiet down, while one of the nurses went to fetch a Ewald tube, a large bore rubber hose we used to irrigate the stomach of those who overdosed on some medication. The patient kept getting more agitated, yelling that he was a doctor, and we needed to release him immediately. Just then, another doctor came walking by, and seeing our patient on the gurney said, “My God, Dr. Walker, what’s happened to you?” As the story unfolded, our patient was in fact one of the new interns on his ER rotation, who fell asleep exhausted on one of the gurneys. One of his ER friends then slipped hard restraints on him, and sent him up to the floor with the note above. He was just a couple of minutes from getting his stomach irrigated when someone recognized him, and saved him from this cruel joke. I never had time to find out how he got back at his “buddy” in the ER, but I’m sure he did.
Another night a young man was admitted, deeply comatose from an attempted OD. He had his stomach irrigated to remove any residual pills that had not yet been absorbed, and treated with IV fluids, oxygen, and close monitoring. Eventually, the effects of the medication he used started to wear off, and he began to wake up. Still confused, he looked around, asking if he was in hell. “No,” the nurse reassured him, “you’re at County hospital.” At which point he began to scream “No! Not County! That’s worse than hell!”
One gentleman, admitted for increased shortness of breath likely related to his excessive smoking and lack of compliance with his heart medication, arrived looking very much like Santa Claus. He had a long white beard, a reddish bulb of a nose, and the appropriate body habitus. He was placed in the red blanket room, next to the nursing station to allow the closest possible observation while we worked on other arriving patients. He was attached to nasal oxygen coming from the nozzle on the wall, while we ordered a chest X-ray and labs. Because of the oxygen in the room, the walls all had large signs printed in red block letters prohibiting anyone from smoking. While working out in the hall, we all of a sudden hear a loud “WHOOSH” coming from the room. As we run in, we see our patient with eyes wide as saucers, sitting up in bed, with his beard completely gone except for a few still smoking curly wisps around his face. Ignoring the signs, he tried to light a cigarette, and…
One call night I heard a loud commotion coming from one of the patient wards down the hall. When I went to investigate, I found the nurse standing outside the room watching an elderly man admitted with alcohol withdrawal standing on top of his bed, swinging his urine bag with the catheter still attached over his head like a lasso, yelling and splattering the walls around him with yellow fluid. I asked her, “Aren’t you going to go in there and do something?” “Yes,” she replied calmly, “but not until he runs out of ammunition.”
I was in the ICU one day, writing a note on one of my patients, when a new patient was rolled in on a bed in the space adjacent to my desk. The orderly and nurse finished securing his oxygen, call button and monitors, then walked away to attend to another patient. Just then, I hear the patient in the adjacent bed go, “Pssst!” to the newly arrived man. He at first didn’t respond until the next, louder “Pssst!” “What is it?” he asks. “I don’t want to scare you, or nothin’, but do you see that little box over your head with all the squiggly lines that’s going “beep,” “beep,” “beep?” “Yeah,” the guy replies. “Well, as I said, I don’t want to scare you, but if that little box stops beeping, you just go real softly “beep, beep, beep” yourself.” “Why is that?” the man demanded. “As I said, I don’t want to scare you, but you know, there was a guy in here before you, and that box all of a sudden stopped beeping. Then all these nurses and doctors came running over here, real mad, started yelling at the guy, and when he didn’t respond, they went and beat him up. Not only that, but they beat him up so bad, they killed him! So if that little box stops beeping, you better go “beep, beep, beep yourself, or the same thing can happen to you!”
One of my more memorable patients was a gentleman in his forties who was admitted with a cold foot, a result of decreased blood flow likely associated with his chain smoking. He was obviously well educated as apparent from his speech and ability to quote Shakespeare and Dylan Thomas, but he refused to allow us to treat his foot appropriately, which was on the verge of developing gangrene. He insisted on using his own poultice consisting of shredded tobacco leaves and some ointment in his pocket as the only treatment. Aside from his rapid speech and delusionary belief in his poultice, he was extremely entertaining and witty – definitely not your average County patient. The psychiatry consultant felt he was bipolar, but refused to declare him incompetent. Eventually, his leg became septic, and his physical and mental condition deteriorated to the point that the surgeons were willing to operate on him, as he no longer had the capacity to make his own decisions. He was transferred to the surgery service, where he had his amputation, survived, eventually ending up on the psych unit for treatment. About a month later, I was walking down the hall near the cafeteria, when I heard someone behind me calling me by my name. It was my patient with the amputation, in one of the County wooden wheel chairs coming up behind me. Turns out he was an English professor at one of the local colleges before he got sick, but he was now on the psych unit. He seemed very happy to see me, and then told me, “You know what those psychiatrists are trying to do to me? They’re slowly trying to drive me SANE! And the people they have locked up over there? They’re the ones too sane to be working over here.” After my last call night, I couldn’t completely disagree with him.