Thursday, August 30, 2007

Mister B's Midnight Serenade

The shift had been an exciting one from the time I arrived. I had some very challenging and complex patients for the first half; all but one of them ended up in our ICU. The one exception was sent to a higher level trauma center for his injuries. That patient was a teenaged Homo jackassii who had attempted to car surf and had managed to get up to somewhere around 30MPH when the car reached an intersection and the dufus kid's "friend" slammed on the brakes. The kid shattered both of his ankles, nearly tore one of his feet completely off, shattered both wrists, had an open fracture of his left clavicle, had most of the skin on his right face gouged away, and suffered skull and facial fractures. (He lived, and he'll have the rest of his life to contemplate the error of his ways.)

In spite of those highlights, most of the cases were pretty much what our ER sees on any given day: nausea/vomiting/diarrhea, pregnant/spotting, migraine, back pain, kidney stones, appendicitis, and an angry gall bladder.

And then there was Mister B.

Mister B was an elderly gentleman who came in by aid car at 0200 from his nursing facility with a complaint of "altered mentation." What that meant was that he was acting strangely for some unknown reason.

We immediately began working to rule out the life-threatening stuff, which took all of ten minutes. The first clue to the cause of Mr. B's confusion was his urine. Without going into too fine a description, the best terminology with which to describe it would be "just naaaaaaasty"

Soon, the lab results confirmed what our eyes (and noses) had already deduced: Mr. B had himself a rip-snortin' kidney infection.

A note about the elderly and how they respond to infection: They don't always show the same set of symptoms as younger people do when they have infections- even severe infections, such as the one suffered by Mr. B. The elderly human body's response to infection is blunted; their immune systems are not nearly what they once were. So more often than not, the first sign of infection in an elderly person is not fever, but confusion- or in medical jargon, "altered mentation."

Mr. B was demonstrating "altered mentation" in rather spectacular style. While the MD was examining him, Mr. B. got out of bed and asked her to dance in a clipped Hoboken accent: "Come on, babe- let's have at it." This MD is a real prizewinner- she's one of the keenest, wittiest docs I know; she is also a dyed-in-the-wool Ole Miss Southern Belle. She deftly parried Mr. B's advance with a flash of a smile as she relplied, "Lookit yew, askin' me ta dance and Ah don't even know yew. Darlin', let's just set a spell and get to know each other first." She took Mr. B's hand and with her free hand patted the stretcher.

"Mr. B winked at the MD, clapped his big paws together and and said with a grin, "Dat's just wonderful!" as he parked his butt right back down on the bed. I breathed a sigh of relief as Mr. B settled down, because had Mr. B so much as tried to jitterbug he would have pulled his Foley catheter right out.

Having averted that crisis, we managed to get Mr. B settled into bed. He fell asleep after a few minutes and I set about catching up on my charting. It was now around 0300, and the ER was empty save for another elderly man and his sick wife in the room next to Mr. B.

And then, from Mr. B began singing:

Ohhhh, the liquor was spilled on the barroom floor and the bar was closed for the night...

Every head in the staff area snapped upright and tilted toward Mr. B's room. The MD cocked an inquisitive eyebrow at me. I shrugged and looked into the room; Mr. B was lying flat in bed, and he continued to the next line:

When out of his hole came a little brown mouse that sat in the pale moonlight...

"What is he singing!? the MD whispered.

I recognized the song. It was a drinking song my dad (who flew attack jets in the Navy during the Vietnam war) and his squadronmates sang whenever they got together and had put a couple of scotches into the tank. Then I recalled seeing a faded tattoo on the patient's forearm: it was the badge of a Navy fighter squadron that had gained considerable acclaim during the Second World War in the South Pacific.

So Mr. B was a Navy fighter pilot, I thought. That explains why he knows that song.

I came about this revelation by pure chance; I am an amateur WW2 naval aviation historian. It's been my hobby for decades. I have just about every book written on the subject, including squadron rosters and listings of aces (pilots credited with five or more confirmed aerial victories). So as I tumbled the emerging data in my mind, I suddenly made the connection with Mr. B and the fighter squadron whose badge was tattooed on his arm, and I sat up and blurted, "Wow!".

"What is it?" The MD asked with concern.

I explained my discovery to all within earshot: Mr. B was a gen-u-ine WW2 fighter ace with 9 confirmed victories to his credit. This guy was an honest to goodness hero!

"Wow..." The gang replied in awe.

"...But what about the song?" The MD prodded after a few moments of courtesy.

"It's called Little Brown Mouse," I whispered, still a little amazed about the identity of this amazing man who was now lustily bellowing that old Naval Aviator's drinking song.

"You actually know this song?" the MD challenged.

"Oh, heck yeah. I learned it when I was about five years old. It took years for my mom to forgive Dad," I recalled with a laugh. (It would not have been so horrible had I not chosen to sing it at catechism. Sister Margaret was not amused.)

Mr. B pressed on with a startlingly pleasant, sonorous baritone voice:

Well, he lapped up the liquor from the barroom floor as back on his haunches he sat...

"It sounds harmless enough," one of the nurses added. It's kind of charming."

"Ohh, just wait," I said with a wicked grin.

And all night lonnnnnng, you could hearrrrrr himmmm roarrrrrrrrr...

We all waited. And waited. And waited.

Then Mr. B repeated: And alllllll night lonnnnnnng, you could hearrrr himmmm roooooooooooar...

More silence ensued. Once again, and with an edge of what sounded like impatience, Mr. B reiterated:


"Oh my gosh! He must have forgotten the last line!" I said with a laugh.

"Well, go help him out!" the MD shot, slapping me on the back to urge me on.

"I dunno, guys..." I said with some trepidation. Are you sure you want to hear the last line?"

"YES!" replied every nurse, MD and ER Tech at the station.

The elderly man next door to Mr. B added from the darkness of his room, "It's driving me crazy! For God's sake, help the poor SOB out!"


"Okay. But But don't say I didn't warn you!" I disclaimed with a wag of my finger. I stood up with a sigh and strode resolutely into the room as Mr. B repeated the line with an "I-can't-remember-that-last-frigging-line-and-it's-really-ticking-me-off" bellow:


As he finished the line, I bent over and whispered in his ear. His eyes snapped open with a start; Mr. B looked at me, grinned wickedly, shook my hand and said, "Say, thanks, sport!"

"It is my pleasure, Commander B," I replied with a wink as I pointed at his tattoo. I patted his shoulder, stepped back, and rendered a salute. Mr. B looked at the tattoo with dismay, looked at me, made the connection in his mind, and returned the salute smartly.

As I exited the room, Mr. B picked up where he left off, and I leaned against the sliding door to his room with my arms folded and my eyes cast heavenward in mock reverence, and mouthed the words as he bellowed:

And alllllllll night lonnnnnnng, you could hearrrr himmmmm rrrrroooooooar...


Somebody shrieked- I think it was the MD. I also heard a stifled snort from the elderly gentleman and his wife in the next room.

And in spite of the bawdy humor of the song, I took a bow back out at the staff area amid rousing applause. Our genteel Southern Belle MD was doubled over, clutching her sides and shrieking.

I escorted the hero upstairs shortly thereafter. He recovered and went back to the nursing facility, clear-headed and stronger, two days later.