Consciousness Raising Exercise #9

Emergency Room work can be intensely gratifying. But there are times when E.R. duty can also be demoralizing. Job-related depression does not just stem from having a patient die under your care. It can stem from a growing awareness of man's inhumanity to man.

The television scripts developed for medical soap operas such as "General Hospital" and "E.R." neatly focus attention on a variety of social issues. But they all go through an intense editorial process. Real life is much messier than what one watches on television. Nor is it interrupted for commercials from your favorite sponsor.

In addition to all the gunshot wounds, stabbings, motor vehicle accidents, and mugging victims, Emergency Room personnel are frequently confronted with victims of child abuse, domestic violence, and the most appalling kinds of stupidity. Whether a patient's judgment has been severely warped by drugs or the patient is hopelessly naive, triage teams continually discover that the things people can (and will continue to) do to themselves evidence an appalling lack of respect for the human body.

Regardless of the obvious need for patient education, each of the following cases required immediate attention from a trained physician. Some of these cases resulted in admission to a full-service hospital bed. Working with another physician or medical student, use each of these scenarios as a step-off point for creating a complete history and physical on the patient:

An obese teenager who does not speak any English enters the Emergency Room accompanied by her anxious mother. The patient is complaining of severe abdominal cramps. Once she is placed on the examining table with her legs spread apart, the physician discovers that the young woman is crowning. Although the patient is about to give birth, both mother and daughter swear through an interpreter that they had no prior knowledge the young woman was pregnant!

A middle-aged Hispanic man from Northern California crosses the Mexican border in search of a cure for a nonspecific ailment. While in Tijuana he seeks out and manages to locate a witch doctor who gives him an unnamed, unlabeled, milky substance to ingest. By the time the patient returns to the United States his entire body has turned a grotesque shade of green. Instead of immediately going to an Emergency Room in Southern California, he insists on driving home (approximately 600 miles). Against his vehement protests that he only wants to be treated by a witch doctor, his confused and terrified family finally takes him to a local Emergency Room.



• An 85-year-old female patient is brought to the Emergency Room by ambulance after she calls 911 while trying to resuscitate her doll. She tells the Emergency Room physician that she knows the doll is not real, but states"To me, it's real."



• A man who has been having marital problems remembers someone telling him that, by using a glass bottle like a vacuum pump, he can simulate the sensations of fellatio. Without giving the matter much thought, he sticks his penis through the neck of a bottle and, after becoming erect, discovers that the bottle won't come off. When he arrives at the Emergency Room in a trenchcoat he refuses to talk to the triage nurse and insists on speaking only to a male physician. When the doctor explains that he will have to break the neck of the bottle with a hammer in order to remove it from the patient's penis, the patient becomes hysterical.



• A pregnant and illiterate teenager comes to the Emergency Room complaining of a bloody discharge. After she has been taken to X-ray it becomes obvious that she has been inserting little plastic boats into her vagina. Her explanation?"I wanted my baby to have some toys to play with until he came out."



• A young man comes to the Emergency Room complaining of abdominal pains, pain on urination and "a generally slow stream." After a variety of other tests prove inconclusive, an ultrasound is performed which reveals several small objects in the patient's bladder. Upon further investigation, these objects turn out to be peanuts. When informed of the discovery, the young man (with a mixture of embarrassment and surprise) confesses that "My old girlfriend liked to play a game she called 'Feed the Elephant,' but I ever really knew what she meant -- I was usually pretty drunk at the time."