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Medical Humanities

The Emergency Room

Tyler Bertroche - Weathered Love

Dan-Vinh Nguyen


“Jesus Christ.” Dr. O said. She wiped the sweat from her brow with a clean spot on her forearm. Her gloved hands were covered in blood. It streaked across her plastic face-shield and large swaths tracked all over the front of her plastic gown.

“It looks like a goddamned Tarantino movie in here,” she said. “I don’t know where there isn’t any blood.” 

Everyone in the emergency department knew Mr. M. They could tell it was him from his yells across the room, his insults. They knew from his smell. He always came in drunk, found down somewhere. He had a long, green jacket over some long johns, t-shirts and sweaters. His ragged, brown-stained jeans were two sizes bigger than his body. Everything about him was disgusting. 

This time, he walked in and said he didn't feel too good. A little blood was streaked on his teeth and dripped down the left side of his mouth. He sat down on one of the seats in the empty waiting room and then blood spewed forth from his mouth, as if an invisible fountain inside sprang to life.

“He’s always such a jackass,” said Dr. O. “Every time he comes in, he’s always cussing at us. Never thankful. He’ll get a meal, some saline, and leave. Everyone’s told him to stop drinking. He’ll never stop.”

Now, two saline bags and two units of blood were nearly empty. The thin tubing that led from the overhanging bags went across Mr. M’s chest, entangled with the three other wires clipped to sticky chest pads. The tubes ran down his body into a catheter hastily placed in his groin. Some blood flowed down his right thigh, trickling onto the bed, soaking remnants of jeans that had been cut off of his body. His face was barely recognizable, his beard covered in blood. His eyes were half open. They were once a fierce, wild blue- now grey and dry. 

“His blood pressure’s dropping,” a nurse said. “Do you want to give him more blood?” 

Dr. O knew that he needed it desperately. He also needed gastroenterologists, surgeons, interventional radiologists, and an intensive care unit. But St. Anthony’s was a small hospital. The emergency department had a dozen beds, a handful of nurses and techs and only one doctor on at a time. It was a slow night and there were no other patients- just Mr. M. And he walked in by himself. 

She could just tell everyone to stop and walk away. Stop caring and he dies. No fuss, no more having to deal with this wretched patient. 

Years ago, when Mr. M first came in, he was 34 years old with no past medical history, brought in by the police for public drunkenness. Dr. O was also there that night, but she didn't remember. That first day, Mr. M had just lost his job at the local car lot. He had a habit of taking sips of vodka out of a water bottle in between customers, as did some of the other salesmen. He got fired when his sales dropped.

Dr. O had just graduated from residency, eager to establish herself as independent and capable. To her, it was a fun challenge to run the department alone on her shifts. Slow or busy, she liked not knowing what or who would exactly come through the door- from sore throats to heart attacks. She was efficient and fast with patients. The rest of the staff quickly grew to like her. 

Mr. M became an increasingly frequent patient. Two years ago, he came in handcuffed to the ambulance bed, violently thrashing around. His wrists were red with lines pressed in from the hard metal. One of the EMS workers had a fractured jaw when Mr. M kicked him in the mouth during transit. When he got to the ED, Mr. M spat on two of the nurses. He spent the next several minutes screaming obscenities at anybody nearby until Dr. O injected him with haloperidol. For the next several hours, he laid in a stupor.

Dr. O remembered a time when he had fallen down and lacerated his left shoulder. She had to sew it closed and just as she was finishing, he suddenly rolled over and she stuck herself with the needle. He laughed at her and then fell asleep.

Countless nurses had come to her with angry red faces, victims of Mr. M’s endless verbal abuse. He came close to getting kicked out of the ED a couple times, but seemed to always know when to stop.

Over the last year, Mr. M was less angry, but more pitiful. He had the same clothes on each time he came in for the past couple months. That long, green jacket had pockets full of papers. He spit and yelled a bit less. Each time, he was just passed out. He was only 48 years old, but looked 20 years older. A salt and pepper beard grew close to touching his chest. His few remaining teeth were yellow and worn. The molars had no ridges, eroded by alcohol and neglect.

“Doctor, his blood pressure is dropping,” the nurse said. “What do you want to do?”

Seconds passed by slowly. The monitor beside his bed read a blood pressure of 84/43. His heart rate was 125 and the alarms kept chiming. The mechanical ventilator squeaked and sighed, out of sync with Mr. M’s erratic breathing and gurgling. 

An old photo fell from one of Mr. M’s jacket pockets.

“What is that?” Dr. O said.

The nurse bent over and picked it up. There were two neat creases criss-crossing the photo. It was crinkled and faded. A man in his 20s cradled a little baby girl a few days old with a small blue bow on her head. Her eyes were closed, swaddled in pink. He looked up at the camera with a foolish grin and kind, blue eyes. He was cleanly shaven with stylishly long brown hair. 

Dr. O looked at the picture and then at the nurse. She took off her gown and gloves and tossed them into the hazard bin.

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