Wednesday, April 22, 2020

Emergency Room Notebook, 1977

You never hear sirens in the emergency room — the drivers turn them off on Webster Street. I see the red backup lights of ACE or United Ambulance out of the corner of my eye. Usually we are expecting them, alerted by the MED NET radio, just like on TV. “City One: This is ACE, Code Two. Forty-two-year-old male, head injury, BP 190 over 110. Conscious. ETA three minutes.” “City One … 76542 Clear.”

If it is Code Three, where life is in critical danger, the doctor and nurses wait outside, chatting in anticipation. Inside, in room 6, the trauma room, is the Code Blue team. EKG, X-ray technicians, respiratory therapists, cardiac nurses. In most Code Blues, though, the EMT drivers or firemen are too busy to call in. Piedmont Fire Department never does, and they have the worst. Rich massive coronaries, matronly phenobarbital suicides, children in swimming pools. (...)

I like my job in Emergency. Blood, bones, tendons seem like affirmations to me. I am awed by the human body, by its endurance. Thank God — because it’ll be hours before X-ray or Demerol. Maybe I’m morbid. I am fascinated by two fingers in a baggie, a glittering switchblade all the way out of a lean pimp’s back. I like the fact that, in Emergency, everything is reparable, or not.

Code Blues. Well, everybody loves Code Blues. That’s when somebody dies — their heart stops beating, they stop breathing — but the Emergency team can, and often does, bring them back to life. Even if the patient is a tired eighty-year-old you can’t help but get caught up in the drama of resuscitation, if only for a while. Many lives, young fruitful ones, are saved.

The pace and excitement of ten or fifteen people, performers … it’s like opening night at the theater. The patients, if they are conscious, take part too, if just by looking interested in all the goings-on. They never look afraid.

If the family is with the patient it is my job to get information from them, to keep them informed about what’s going on. Reassure them, mostly.

While the staff members think in terms of good or bad codes — how well everyone did what they were supposed to do, whether the patient responded or not — I think in terms of good or bad deaths.

Bad deaths are ones with the manager of a hotel as next of kin, or the cleaning woman who found the stroke victim two weeks later, dying of dehydration. Really bad deaths are when there are several children and in-laws I have called in from somewhere inconvenient and none of them seem to know each other or the dying parent at all. There is nothing to say. They keep talking about making arrangements, about having to make arrangements, about who will make arrangements.

Gypsies are good deaths. I think so … the nurses don’t and security guards don’t. There are always dozens of them, demanding to be with the dying person, to kiss them and hug them, unplugging and screwing up the TVs and monitors and assorted apparatus. The best thing about Gypsy deaths is they never make their kids keep quiet. The adults wail and cry and sob but all the children continue to run around, playing and laughing, without being told they should be sad or respectful.

Good deaths seem to be coincidentally good Codes — the patient responds miraculously to all this life-giving treatment and then just quietly passes away. (...)

I saw blind Mr. Adderly on the 51 bus the other night. His wife, Diane Adderly, came in DOA a few months ago. He had found her body at the foot of the stairs, with his cane.

Ratshit Nurse McCoy kept telling him to stop crying.

“It simply won’t help the situation, Mr. Adderly.”

“Nothing will help. It’s all I can do. Let me alone.”

When he heard McCoy had left, to make arrangements, he told me that he had never cried before. It scared him, because of his eyes.

I put her wedding band on his little finger. Over a thousand dollars in grimy cash had been in her bra, and I put it in his wallet. I told him that the denominations were fifties, twenties, and hundreds and he would need to find somebody to sort it all out.

When I saw him later on a bus he must have remembered my walk or smell. I didn’t see him at all — just climbed on the bus and slumped into the nearest seat. He even got up from the front seat near the driver to sit by me.

“Hello, Lucia,” he said.

He was very funny, describing his new, messy roommate at the Hilltop House for the Blind. I couldn’t imagine how he could know his roommate was messy, but then I could and told him my Marx Brothers idea of two blind roommates — shaving cream on the spaghetti, slipping on spilled stuffaroni, etc. We laughed and were silent, holding hands … from Pleasant Valley to Alcatraz Avenue. He cried, softly. My tears were for my own loneliness, my own blindness.

The first night I worked in Emergency, an ACE ambulance brought in a Jane Doe. Staff was short that night so the ambulance drivers and I undressed her, pulled the shredded panty hose off of varicose veins, toenails curling like parrots’. We unstuck her papers, not from her gray flesh-colored bra but from her clammy breasts. A picture of a young man in a marine uniform: George 1944. Three wet coupons for Purina cat chow and a blurred red, white, and blue Medicare card. Her name was Jane. Jane Daugherty. We tried the phone book. No Jane, no George.

If their purses haven’t already been stolen old women never seem to have anything in them but bottom dentures, a 51 bus schedule, and an address book with no last names.

The drivers and I worked together with pieces of information, calling the California Hotel for Annie, underlined, the Five-Spot cleaners. Sometimes we just have to wait until a relative calls, looking for them. Emergency phones ring all day long. “Have you seen a — ?” Old people. I get mixed up about old people. It seems a shame to do a total hip replacement or a coronary bypass on some ninety-five-year-old who whispers, “Please let me go.”

It doesn’t seem old people should fall down so much, take so many baths. But maybe it’s important for them to walk alone, stand on their own two feet. Sometimes it seems they fall on purpose, like the woman who ate all those Ex-Lax — to get away from the nursing home.

There is a great deal of flirty banter among the nurses and the ambulance crews. “So long — seizure later.” It used to shock me, all the jokes while they’re in the middle of a tracheotomy or shaving a patient for monitors. An eighty-year-old woman, fractured pelvis, sobbing, “Hold my hand! Please hold my hand!” Ambulance drivers rattling on about the Oakland Stompers.

“Hold her bloody hand, man!” He looked at me like I was crazy. I don’t hold many hands anymore and I joke a lot, too, if not around patients. There is a great deal of tension and pressure. It’s draining — being involved in life-and-death situations all the time.

Even more draining, and the real cause of tension and cynicism, is that so many of the patients we get in Emergency are not only not emergencies, there is nothing the matter with them at all. It gets so you yearn for a good cut-and-dried stabbing or a gunshot wound. All day long, all night long, people come in because they don’t have much appetite, have irregular BMs, stiff necks, red or green urine (which invariably means they had beets or spinach for lunch).

Can you hear all those sirens in the background, in the middle of the night? More than one of them is going to pick up some old guy who ran out of Gallo port.

Chart after chart. Anxiety reaction. Tension headaches. Hyperventilation. Intoxication. Depression. (These are the diagnoses — the patients’ complaints are cancer, heart attack, blood clots, suffocation.) Each of these patients costs hundreds of dollars including ambulance, X-ray, lab work, EKG. The ambulances get a Medi-Cal sticker, we get a Medi-Cal sticker, the doctor gets a Medi-Cal sticker, and the patient dozes off for a while until a taxi comes to take him home, paid for with a voucher. God, have I become as inhuman as Nurse McCoy? Fear, poverty, alcoholism, loneliness are terminal illnesses. Emergencies, in fact.

We do get critical trauma or cardiac patients, and they are treated and stabilized with awesome skill and efficiency in a matter of minutes and rushed to surgery or ICU, CCU.

Drunks and suicides take hours of time holding up needed rooms and nurses. Four or five people waiting at my desk to sign in. Ankle fractures, strep throat, whiplash, etc.

Maude, beery, bleary, is sprawled on a gurney, kneading my arm like a neurotic cat.

“You’re so kind … so charming … it’s this vertigo, dear.”

“What is your last name and your address? What happened to your Medi-Cal card?”

“Gone, everything is gone … I’m so miserable and so alone. Will they keep me here? There must be something the matter with my inner ear. My son Willie never calls. Of course, it’s Daly City and a toll call. Do you have children?”

“Sign here.”

I have found a minimum of information among the rest of the mess in her purse. She uses Zig-Zag papers to blot her lipstick. Big smeary kisses, billowing like popcorn all over her purse.

“What’s Willie’s last name and phone number?”

She begins to cry, reaching both arms for my neck.

“Don’t call him. He says I’m disgusting. You think I’m disgusting. Hold me!”

“I’ll see you later, Maude. Let go of my neck and sign this paper. Let go.”

Drunks are invariably alone. Suicides come in with at least one other person, usually many more. Which is probably the general idea. At least two Oakland police officers. I have finally understood why suicide is considered a crime.

Overdoses are the worst. Time again. Nurses usually too busy. They give them some medication but then the patient has to drink ten glasses of water. (These are not the stomach-pump critical overdoses.) I’m tempted to stick my finger down their throat. Hiccups and tears. “Here, one more cup.”

There are “good” suicides. “Good reasons” many times like terminal illness, pain. But I’m more impressed with good technique. Bullets through the brain, properly slashed wrists, decent barbiturates. Such people, even if they don’t succeed, seem to emanate a peace, a strength, which may have come from having made a thoughtful decision.

It’s the repeats that get to me — the forty penicillin capsules, the twenty Valium and a bottle of Dristan. Yes, I am aware that, statistically, people who threaten or attempt suicide eventually succeed. I am convinced that this is always an accident. John, usually home by five, had a flat tire and could not rescue his wife in time. I suspect a form of manslaughter sometimes, the husband or some other regular rescuer having at last finally tired of showing up just in the guilty nick of time.

“Where’s Marvin? Must be worried sick.”

“He’s phoning.”

I hate to tell her he’s in the cafeteria, has gotten to like their Reuben sandwiches.

Exam week at Cal. Many suicides, some succeeding, mostly Oriental. Dumbest suicide of the week was Otis.

Otis’s wife, Lou-Bertha, had left him for another man. Otis took two bottles of Sominex, but was wide awake. Peppy, even.

“Get Lou-Bertha before it’s too late!”

He kept hollering instructions to me from the trauma room. “My mother … Mary Brochard 849-0917 … Try the Adam and Eve Bar for Lou-Bertha.”

Lou-Bertha has just left the Adam and Eve for the Shalimar. It was busy for a long time, then an answer, and Stevie Wonder for a whole record of “Don’t You Worry ’Bout a Thing.”

“Run that by me one more time, honey … He OD’d on what?”

I told her.

“Shit. You go tell that toothless worthless nigger he better be taking a lot more of something a lot stronger if’n he expects to get me outta here.”

I went in to tell him … what? She was glad he was okay, maybe. But he was on the telephone in room 6. Had his pants on, still wore a polka-dot gown on top. He had located the half-pint of Royal Gate in his jacket pocket. Was just sort of lounging around, like an executive.

“Johnnie? Yeah. Otis here. I’m up here at City Emergency Room. You know, off Broadway. What’s happening? Fine, fine. That bitch Lou-Bertha messing ’round with Darryl … [Silence.] No shit.”

The charge nurse came in. “He still here? Get him out! We have four Codes coming in. Auto accident, all Code Three, ETA ten minutes.”

I try to sign as many patients as possible before the ambulances arrive. The people will just have to wait later, about half of them will leave, but meanwhile all are restless and angry.

Oh, hell … there were three here before this one but better just sign her in. It’s Marlene the Migraine, an Emergency habituĂ©e. She is so beautiful, young. She stops talking with two Laney College basketball players, one with an injured right knee, and stumbles to my desk to go into her act.

Her howls are like Ornette Coleman in early “Lonely Woman” days. Mostly what she does is first, bang her head against the wall near my desk, dump everything off my desk with a swoop.

Then she starts her cries. Whooping, anguished yelps, reminiscent of Mexican corridas, Texan love songs, “Aiee, Vi, Yi!”

“Ah-hah, San Antone!”

She has slumped to the floor and all I can see is an elegantly manicured hand, extending her Medi-Cal card above the desk.

“Can’t you see I’m dying? I’m going blind, for crissakes!”

“Come on, Marlene — how’d you get those false eyelashes on?”

“Nasty whore.”

“Marlene, sit up and sign in. Ambulances are coming, so you’ll have to wait. Sit up!”

She sits up, starts to light a Kool. “Don’t light that, sign here,” I say. She signs and Zeff comes to put her into a room.

“Well, well, if it isn’t our old angry pal, Marlene.”

“Don’t you humor me, you dumb nurse.”

The ambulances arrive, and for sure they are emergencies. Two die. For an hour all the nurses, doctors, on-call doctors, surgeons, everybody is tied up in room 6 with the two surviving young patients.

One of Marlene’s hands is struggling into a velvet coat sleeve, the other is applying magenta lipstick.

“Holy Christ — I can’t hang around this joint all night, right? Seeya, honey!”

“See ya, Marlene.”

by Lucia Berlin, Maxima-Library |  Read more:
Image: A Manual for Cleaning Women: Selected Stories
[ed. I'm currently reading Lucia Berlin's "A Manual For Cleaning Women: Selected Stories, and am so impressed (like discovering Raymond Carver for the first time). She's not well known (and died in 2004) so I Googled some reviews to learn more about her work and background. Guess what? I found this website with the entire book reproduced! I'm sure there must be some copyright issues involved, but I don't know. Anyway, here's one (lightly) excerpted story (while the link still exists) for readers who want to get acquainted with her. Purchase the book. Only half way through so far, but also recommend: the title story (AMFCW), Detox, and Tiger Bites.]