Time for Classifieds

Kimberly comes in about once a week.  Early 20's, about 5’2”, weighs 85 pounds and cries the whole time she’s in the ED.  Typical of anorexics, she sits with both legs folded up in front of her on the chair. Obviously plagued by deep-seated mental issues, she pretends she can’t get to the bathroom without help, crumpling into a heap on the floor and crying until someone helps her up and to her room.   

I must confess that I do, on occasion and for experimental purposes only, merely offer the slightest touch on the forearm or lightly hold a hand at moments like these.  The patient will almost always miraculously get right up and walk now that they're being "helped".   

Same thing with wheelchairs. People load their family members into a vehicle, rush to the emergency room, run inside to the admissions desk and demand someone to help them get the patient out of the car.  Our first response is often, "How did you get them IN to the car?"  Nine times out of ten, I go out with a wheelchair, roll it up to the car and stand there holding it in place, a concerned expression on my face, and the patient gets right up and sits down in the chair and nobody realizes they didn't need to drag a nurse away from another patient to roll a wheelchair to the curb, unnecessarily.  I'm tellin' ya, I shoulda been a faith healer.     

I was ready to go home when Kimberly came in at five after six (less than one hour before my shift was over).  Her chief complaint form reads,   I can’t stop throwing up.  A truer statement was never made. 

She was, of course, crying when I called her into triage.  Her Dad, the spitting image of the father in the movie Juno, waited outside but somehow the knowledge of his presence just outside the door concerned me as our interview turned rapidly ugly.

"What's going on today?

Sobbing, "What?"

"Why are you in the ER today, Kimberly?"

“I’m sick,” she drones, eyes closed.  Then more sobbing. 

Another observation:  When a patient keeps their eyes closed throughout the triage interview, there's always a mental component. 

“In what way are you sick?”  I ask her, the back of my neck beginning to tighten.

But of course, she only sobs, burying her face in one hand.

Answering pertinent questions is always too much of a demand for people like Kimberly.  They are disgusted by our need to interview them, expecting instead, that we should intuitively know by some unknown mechanism, not only the nature and duration of their symptoms, but all their medications and the dates of their immunizations.  Or possibly expecting we should rush them to a stretcher, turn the lights down dimly, and stand silently sentinel as her family and friends file solemnly past them, wishing they'd treated them better,  until the patient's condition improves enough to remember the information requireded to provide their safe care. 

Turning back to my computer, I girded myself for what I knew was going to be the dental extraction of information from her.

Meanwhile, I needed to discharge a patient who'd been waiting for 5 hours for CT results which had never been submitted to the distance radiologist by the radiology tech.  Once discovered, it took only minutes to recieve an "all clear" and her chart was ready to go, waiting on the other side of the wall for me to finish with Kimberly's nonsense. 
 

“I’m going to need your arm so I can do your blood pressure,”  I said, my eyes on the computer screen.  When I turned to start her vital signs, I saw she hadn’t removed the heavy sweater she wore despite the 85 degree outdoor temperature, but had, instead, merely stretched her arm toward me still holding her face with her opposite hand, crying without tears.  “I need your arm out of your sweater so I can do your vital signs.” 

A new crop of sobs poured forth.  “I didn’t know what you meant, you don’t have to be cranky!”  

She had no idea how wrong she was about that.  Being cranky is the last thing I have any control over.

Once I sent her back to the waiting area, chart in hand, I was relieved to see another triage slip in the door.  If I stretched this next triage out until I heard the admissions clerk bring Kimberly’s chart back and put it in the rack on the wall, somebody else would have her in a room and take over her care and my role in her ED stay would be officially over. 

 

As I brought the second triage patient's chart back to place in the waiting rack, I heard Kimberly's familiar bellowing emitting from a treatment room down the hall alerting me that my plan had unfolded seamlessly and once completing the next triage, I was back to my original patient in room 2A, finally discharging her home with a prescription and instructions on constipation. 

Cha ching!  I love it when plans come together!