Monday, February 18, 2008

That's Just So Wrong! -Then Again, It Makes Sense...

It was about 4PM on a Sunday. The waiting area was packed with malingering whiney-baws, harried soccer moms and their bruised, violent hooligans, armchair football warriors who tripped over their coffee tables and sacked themselves- right into the TV-, and the "Bucket Brigade" (seasonal GI bug sufferers). I was float RN and I was covering the Charge RN for a lunch break when the Charge RN's phone rang; I picked it up. On the other end was the Triage RN. Her rather hushed tone was laden with, oh, I don't know... a strange, pressured awkwardness, I suppose.

(I am here to tell you: it's damned hard for an ER nurse to feel awkward. Just think of all those tubes we wave around and where we put them.)

Awkwardness usually is not an issue with us unless we encounter something so shockingly unexpected that our brains just sort of go Gah-WOOOOO-gah. It doesn't happen often, but when it does, it can be entertaining.

...Such as in the case of the conversation I was having with the triage nurse.

"Why are you whispering?" I asked.

"I don't want them to hear me," she answered with a very strange lilt and timbre to her voice.

Let me try to recreate the nurse's tone of voice for the reader. Imagine you and your friend are in Dracula's castle and you have found your way to the vampire's crypt. It's pitch dark down there, and your friend lights a match while you are turned the other way. There, illuminated before your friend's eyes by the frail light of the lit match, is the Ole Bloodsucker himself... sound asleep in his coffin.

...But the Count also happens to be dressed in a neon yellow tutu, a huge green foam-rubber cowboy hat, a blue feather boa, and bright red patent-leather seven-inch platform shoes. Oh, wait, wait... And he has on those really, REALLY HUGE plastic sunglasses.

(I know what you're thinking: "Hey, wait! That's Elton John!" Well, that's just ridiculous. Stop being silly.)

Anyway, having recovered from the inital shock, your friend says to you in a voice that tries to convey the full color of what he sees without waking the monster, "Um, there is something over here that might interest you..."

Are you imagining that tone of voice? Yes, that's what I was hearing.

"Okay," I said with an exasperated sigh. "You don't want who to hear you?"

"The strippers!" she snapped in a hissed whisper over the phone (which was, I may point out, actually loud enough to awaken the Count and send him into a frenzy of... of... hmm... well, into a frenzy of whatever the hell he was doing wearing that preposterous getup).

"Strippers!?" I blurted out. The entire Western Hemisphere turned around to look at me. I smiled wanly. It was my turn to feel awkward.

"Yes. Strippers."

"How many?" I asked. Now I really had coworkers tilting their heads toward me to listen. This was looking bad- really bad.

"Six," the triage nurse reported.

"Well, what do they want?" I asked, as if they were a 60 Minutes crew coming to do an ambush interview. (I still roll my eyes at myself.)

"Umm, they say they want to be seen," The triage nurse replied.

"Why else would they be strippers?" I asked drily. (I'm sorry, but I really did say it. It just sort of slipped.)

"Dammit, that's not funny!" she hissed.

"Okay. Okay. I'm sorry." I said, drawing another very heavy sigh. "What are their chief complaints?"

"They are all the same," she answered.

"Hmm... okay, I'll ask. What is it?"

"Rash," the nurse answered flatly.



After fighting very, very hard to keep imagery and snappy remarks at bay, I asked, "Do they have fevers?"

"Umm..." I heard the nurse rifling through papers; then, "No."

I looked at the bed board. Quick Care was just opening, and had ten beds. All the other patients were going to need more complex care, and those beds were opening up soon.

"Okay. Send the six of them to Quick Care along with the two people with finger lacs (cuts), the migraine patient, and the one with the ankle injury.

"The ankle injury has a nine-year-old son with her."

"Put her in a room that has a DOOR."

"Okayyyyyy. Bye-bye."

I hung up the phone. The Charge RN arrived from lunch a few minutes later.

"Everything okay?" she asked.

"Yep. No problems," I said.

"Great. Let's see here," she said, looking at the assignment sheet. "Oh!" Quick care is full, and there is only one nurse and no ED Tech. Why don't you go help them out until 1900?"

(Cue Symphony of "Oh, Crap" in D minor.)

"Uh, sure. Okay."

The Charge nurse tilted her head, looked closely at me, and asked, "Are you okay?"

I must have actually gone pale. I thought I just thought pale.

"Yeah. I'm okay."

I walked like a condemned man to Quick Care.

The, um, entertainers were given their own rooms, handed warm blankets, and instructed to change in to the gowns provided to them. I gave them time by seeing first the ankle injury, and then the migraine (a frequent flyer). Grabbing the first clipboard, I knocked on the wall and asked the patient if I could come in.

"Sure," she answered.

I pulled the curtain and walked through. The woman had her gown on "Hollywood style" (that is, open in the front). And untied. Hanging rather loosely open. (If they were real, they were spectacular.)

While looking at my shoes, I instructed the patient that the gown was to be open in the back (in the BACK, for God's sake) and exited the room.

It was the same with the other five strippers.

During the interval in which the strippers were correcting their gowns, the MD came in. It was the darling, slight, quiet, staid MD from Ole Miss herself.

Dear God, I am sorry for whatever it was I did to deserve this fate. Please can you make it stop now?

The MD hummed to herself as she looked through the charts. Looking at the migraine sufferer's chart, she asked, "Typical migraine?"

"Yes, Ma'am."

"She has a clinical alert. No narcotics for the Princess. It's Toradol and Compazine in the butt for her," she said, scrawling the order on the chart.

"Got it. I have also put in the order for a three-view ankle X-ray for the patient in Nine. Status-post hysterectomy."

"Great!" chirped Ole Miss.

"Both finger lacs have up-to-date tetanus shots, and have been infiltrated by Mags (the other RN).

"Awesome." The MD then began looking over the remaining six charts. After the third stripper's chart, the humming stopped and Ole Miss furrowed her brow.

"We have six patients with rashes."

"Yes, we do. They are all entertainers from the same, um, establishment."

Ole Miss looked up at me and cocked an eyebrow. Then she caught my meaning.

"You mean they're all strippers..." The MD said flatly.

"Uh, yes. They are all strippers."

"Oh, crap. They never learn, do they?" the MD said as she turned on her heel and strode to the first stripper's room. After knocking, the MD entered the room as I followed her with the patient's chart.

"Where is your rash?" asked Ole Miss.

"Oh, it's all over!" answered the stripper, who stripped off her entire gown to emphasize her point.

Oh, God. Get me out of this.

The reddened areas were, indeed, everywhere, but in a discreet pattern. The patient had red areas to her inner forearms, her inner upper arms, between her breasts, running in a straight line down her abdomen, along both inner thighs, and on her inner calves.

"That's not a rash. That's cellulitis." The MD said.

"What's that?" the stripper asked.

"A bacterial skin infection." The MD answered. She scribbled an order for an oral antibiotic on the chart and departed the room. I told the stripper to please (PLEASE!) put her gown back on and left the room.

I caught up with the MD in the next stripper's room. Same nonchalant exposure, same pattern of reddened skin, same diagnosis. Same plea to re-cover. Same hasty retreat.

The scene was repeated on down the line. Finally, completely exasperated, the MD had all six strippers get dressed (inasmuch as their street clothes allowed for it) and come into one exam room.

Having gathered the girls together, the MD handed discharge instructions and prescriptions to each girl, sat down heavily, sighed, and finally poleaxed the six of them with four words:


The MD then stood up and left the room, shaking her head.

The strippers looked at each other with "Hey, wowwwwwww" expressions. The light came on for a moment- perhaps flickering and crackling from a short in the wiring somewhere, but at least it was on.

I handed each a large, hideously bitter antibiotic tablet and a cup of water.

"Umm... any questions?"