Life in the ER: Alive but ungrateful
Monday, February 28, 2011
By Dr. Thomas A. Doyle
She was 19 and she was dead. Skin like a gutted trout’s belly, lips the shade of rotting grapes, not moving or breathing. Her pupils were tiny lead pencil tips, murky and dull. She had been unceremoniously dumped on our doorstep, literally tossed out of a car which peeled away the moment the door was closed. A fresh needle track peeked out of a thatch of old ones in the crook of her left elbow.
Yes, she was dead. But as Billy Crystal said in “The Princess Bride,” she was only mostly dead. She was just taking death out for a test drive, putting a down payment on the farm, sightseeing on the Stygian ferry, tapping the bucket with her toe. Luckily for her, mostly dead is a little alive.
Our team descended upon her and in moments she had a working IV line and oxygen was being forced into her lungs via a bag/mask device. I ordered Narcan, an antidote to overdoses of opiates such as heroin or Oxycontin.
The change was nearly instantaneous; she squirmed on the stretcher and gulped a huge gasp of air. Her eyes snapped open, pupils returning to normal size. She began thrashing about on the bed, tearing off monitor leads, yanking out her IV.
“Relax, sweetie,” soothed our charge nurse, who could pose as the Norman Rockwell archetype of a kindly grandmother, “You’re going to be OK.”
“Don’t you ‘sweetie’ me, bitch!” our modern Lazarus squawked, slapping away the nurse’s hand. She tugged at her gown. “What the hell is this? Where’s my shirt?” Her fingers found the shreds of the grimy sweatshirt we had cut off during the resuscitation. She eyed us accusingly and whipped a piece at the wall. “You cut my [expletive] shirt! You [more expletives] cut my shirt! Y’all are going to pay for this.” Wagging her finger in my face, she listed her demands. “I want a shirt. I want a taxi. I want my wallet, my cell phone … and give me something to drink, my mouth tastes like crap!”
I picked up the shred of sweatshirt and dumped it in the trash. I pulled up a stool next to the stretcher and stared silently at her. After a few seconds of trying to ignore me, she snapped her head around, shoved her nose a couple of inches from mine and bellowed, “What’s your problem!?”
“You’re welcome,” I said softly.
She replied with an additional string of expletives, including some rather creative ones questioning my parentage and sexual orientation. I continued to stare back. Finally I interrupted and said, “You know you just about died.”
All that earned me was a sullen glare.
“Next time might be too late.”
“If you’re interested, we could try to set you up in rehab …”
“Screw rehab!” she exploded. “Just let me out of here!”
“Fine,” I replied, tossing my hands up and heading for the door.
As I approached the threshold, I heard her muttering. “Rehab! Yeah, like you care about me.”
I halted, mulling it over for a moment. I pivoted on my heel, crossed back to the bed and answered, “You know what? You’re right. I don’t care about you. Who are you to me? Some nobody I’ve never seen before and, at the rate you’re going, I’ll never see alive again.
“I do care that another human being, one just a few years older than my daughter, is completely ruining her life as well as the lives of anyone who ever loved her. But I’m not one of those people. I don’t love you. After seeing how you treat people who help you, I don’t even like you.”
Her mouth popped open to respond, but she seemed momentarily taken aback.
I lowered my voice and continued, “I can only hope you have somebody who still loves you. A mom, a dad, maybe a baby brother or sister. I mean, for God’s sake, you’re 19! It tears my heart out to think that only a few years ago you were probably playing hide and seek and bringing home fingerprint art and dressing up as a puppy in the school play. But in the end it doesn’t matter if I care. It only matters if you care. If you don’t, then why should anybody else?”
“Just get out of my face! You don’t know shit about me!” she spat.
As I tromped out of the room, I bumped into the charge nurse.
“That Narcan sure works fast, doesn’t it?” she commented.
“Yep,” I agreed. “She went from dead to asshole in 60 seconds.”
That garnered a melancholy chuckle and a sagacious glance over her glasses. We walked a few steps then I pulled her aside.
“Hey, listen, make sure social services sees her before she leaves. It probably won’t do any good, but at least give the kid another chance.”
Stepping back, I clapped once and rubbed my hands together. “OK, then. What’s next?”
“A family of three kids who ate cat food in room 7 and an old lady who’s convinced she has worms in her ear in room 12.”
“Of course,” I sighed. “Just another day at the office …”
Three hours later, at the end of my shift, the social worker stopped me and said, “I sent that girl to Gateway.’
“Really?” I replied. “She agreed to go to rehab?”
“Yeah, she’s on her way. By the way, I’m not sure what this means, but she wanted me to tell you it wasn’t a puppy. It was a giraffe.”
Dr. Thomas A. Doyle is a specialist in emergency medicine who practices in Sewickley (firstname.lastname@example.org).