Gang Grrrl

The patient in my first bed was discharged but it wasn't long before I got a new one, and she sounded like a handful. Before I even went in there I figured her for a head case. Among the things I heard her say from behind the curtain was "you may as well put me in jail now because when I get out of here I'm picking up my Glock and pop!, pop!, pop!". Alrighty then. I decided not to document the Glock comment because if I charted homicidal ideation I'd have to stick her in the psychiatric room.

Armed with orders for lab work, a fluid bolus and morphine I went in. I asked her what happened and she told me she was in a gang fight. Just making conversation I asked her what gang she was in. I didn't understand what she told me, but it wouldn't have mattered anyway. This isn't much of a gang town. It's more of a bunch of freelance idiots doing crimes and other dumb shit independently. Most of the gangs we do have are from the largely Hispanic southwest neighborhoods. She confirmed being from that part of town but she didn't look Latin to me. And she had an Irish name.

Putting an IV in her was like putting a cat in a bag, but I got it on the first try and earned her trust. She proclaimed me good. She also said that this injury hurt more than when she was shot ten years ago. I asked where she went that time and she said nowhere. Some friend took the bullet out. I pictured a scene from an old movie: a shot of whiskey, bite down on a leather strap and some back room doctor doing his thing.

X-rays confirmed a fracture and orthopedics showed up pretty quick and casted it. It was a simple break, the bones well approximated, and after another x-ray they pronounced her good to go, but with an alcohol level of 0.29% she wouldn't be going anywhere right away. I figured she'd be here well after I went home for the night but then a security cop showed up asking her about some friend who wanted to take her home.

The friend had some beat up old car in the driveway. This was another story in itself. The car was running but he was locked out. He had a key to the trunk but the door key was broken off in the lock. He said my patient had another key to the door. I confirmed that she had the key and was okay to go home with this guy. He was pretty sketchy looking but he said he was sober and I didn't smell any alcohol on him. If he was a serial killer it was fine with me as long as he wasn't drunk. I got some crutches and directed a tech to get the woman out of here. Even though I was her new best friend, I had had enough of her.

I wondered if this loser, the driver, was in the gang too. I was picturing a pretty pathetic gang here. For some reason I thought of that old Groucho Marx quote. You know the one. Paraphrased, it goes something like I wouldn't join a gang that would have me as a member.

Detective Work

He came in looking for Dr L. Kind of an unusual looking chap, tall with thick glasses and a pork pie hat. And he was white. Said he was a detective. Not many white guys make it that far up in the department these days.

Dr L wasn't around, but I wasn't busy so I took the time to find out when it would be a good time to come back. He wanted to get the doctor's opinion of a shooting victim who came in the week before. The detective thought the guy was full of shit. His suspicion was that he shot himself but he had left the ER before the X-ray results came back. Probably nervous about the police sniffing around.

The detective said he called the patient at home a few times but he just asked why he was bothering him. "He's got warrants. I think I'm just going to send some of my guys out to pick him up." Good plan, if he's not already dead from infection.

As a last thought I figured I'd find out which resident saw the guy. The police always get the name of staff but it's the residents who spend real time with the patients anyway. I took the detective into a resus room to use the computer. He gave me the guy's name and I found it but, hey, there was a return visit just a day before. Detective asked me what that was about and I explained that privacy laws precluded me giving any details without a warrant. I had a pretty good idea, though. It looked like he just missed the resident too.

After the cop left, I opened up the more recent chart to confirm my suspicions. Yep, he had returned with a raging infection. The wound was red and draining pus. This is why you want to stick around and get your injury treated, but he was probably so nervous from talking to the police that he limped away at the first opportunity. And he would have been limping, seeing as how he was shot in the foot. Chances are good that he did do it himself. He wouldn't be the first gangster who shot himself while putting a gun in his belt.

Turkey Sandwich

Okay, Let's make this clear right now. I'm not giving you two dollars. Save your story. It's not what I do...

But perhaps I should start at the beginning. Tonight's, or Sunday's, theme was Needs That Aren't Going to be Filled. Yesterday it was cranky old people, tonight it's unfilled needs. It started when I took report on my new patients. P told me that the first woman's family had asked for turkey sandwiches. First off, we don't have turkey sandwiches. What we do have is shortbread cookies, cheese and cracker snacks, and apple juice. Sometimes we have pudding cups and strawberry applesauce, but not tonight. Pudding and applesauce won't be happening tonight, and turkey sandwiches are like never. If you find one let me know because I'd like a turkey sandwich too.

P said she gave the guy and the kid some juice and crackers. That's more than I would' ve done. Apparently she directed them to the cafeteria but they said they didn't have any money. And that's our problem because...?

My next patient encounter was with some woman who was asking where the doctor was. There're a lot of doctors, so I asked who the patient was. Dr K had just picked up the chart and I told him that he was wanted so he saw that one first. I should have asked what they wanted, but it wasn't my patient and I got lazy. What they wanted, or maybe I should say what they didn't want, was to wait. It was no emergency. Just young people who didn't want to wait. A few minutes later when she asked me if we had any toothbrushes I told her you can buy those at the store. She looked at me for a few moments before it registered that I had no interest in giving out fucking toothbrushes and then she started in about "smart ass motherfuckers" and how she always gets attitude in this place. Hey, ask a stupid question....

Next patient, I couldn't figure out exactly whey she was here, caught me passing by and asked if we "had any of those snack pack things or a sandwich". She hadn't been in the place ten minutes, but she'd obvously been here before if she knew enough to ask for a snack pack because that's exactly what we call the paper bags that we're out of tonight. I told her I couldn't feed her before a doctor saw her, and when the doctor went in there she was gone. Whatever the emergency was it wasn't important enough to merit a twenty minute wait.

And so it went. The turkey sandwich people eventually disappeared, the woman said they went to church for some food, and when they came back they started bugging me about when a disposition would be decided on. They told me something about parking the car that I really didn't understand, and then went into how there was a problem with their bank card and they didn't have any money for food. I wasn't going to offer anything, I just don't see feeding every Joe who wanders in here as part of my responsiblities, but E came by with some leftover fundraising food and gave them some. Then they aksed me for juice, but I gave some noncommittal response and they eventually forgot about it, or maybe they cadged some off of someone else, but then the fucker had the nerve to ask me for two dollars. He needed gas money. I told him we don't do that and he answered back that "you don't wanna do it". "How about I'm not gonna do it?" As I walked away he said, again, "you don't wanna do it!". I can't say he was wrong, but it's just semantics to me. They weren't getting money off me and the patient was eventually discharged. If they end up living in their car for want of two dollars worth of gas it'll be somebody else's problem. I wonder how many of you out there have jobs where you have to pay the customers to leave.

After midnight my patient mix flipped over to people who were really sick. One new patient, a relatively young one who's HIV positive, appears to have meningitis. Of course I took no precautions when I first approached him. He wasn't in isolation or anything, so that's something to look forward to. At least I'm done with people demanding food, or so I thought. Some gnarly old guy accompanying an even gnarlier and older patient just stopped me and said "it's not for him but I was wondering if I could have one of those snack packs". I told him not right now. In an hour I'm moving to triage and if my relief wants to feed everybody that's fine, but I'm not playing waiter here. Fortunately, I don't depend on tips for my income.

P.S.: You know, I was thinking about giving that last old guy some food just so you all don't think I'm just a mean fuck. I didn't do it, and when I gave off report to my relief just now and suggested she could feed him if she wanted I got "what am I, a fucking waitress?". 'nuff said about that.

The Complainer

This guy, hands down, had to be the biggest idiot of the day. I was at the front desk, working my way through a big pile of slips, when the advocates brought my attention to a man who was trying to stir up trouble in the lobby. I'll call him Richard. Richard Tard. Mr Tard was telling the other patients waiting that they needed to start complaining. They all had emergencies and shouldn't have to wait, so the advocate called for a coordinator to come out and handle him. S was carrying the phone and a minute or two later she was at the desk.

As luck would have it, I had finished with the next to last slip in the pile. The only one remaining belonged to Mr Tard himself. S said that she'd write Dick in, and I told her that was probably a good idea because if she thought he was agitated and pissed off now, wait until I had two minutes a few seconds with him. I gave up the desk to her for some customer recovery. I already knew that his complaint wasn't particularly urgent, it was the kind of thing that might be the lowest level of emergency but probably wasn't even that. I also knew that he hadn't been waiting more than twenty minutes altogether. S wrote him in, took him back for the triage assessment and gave him a comment card for his complaints.

The comment card was a big problem with him. It wasn't sufficient. He needed the "official form"; one he could take to his lawyer. Unfortunately, there's no such thing here. S said she thought about making one up as a Word document just to shut him up. If it was me, I would have done it and told him to fill it out in triplicate. Then I would have shredded it. These complainers are all the same, they're nuts, and when they start singing about their lawyers it just confirms it. This customer, Dick Tard, was dropping the name of his lawyer. Usually it's the TV lawyers, ones we know, but this time he was talking about "Mr Smith". Yes, that was his real name. I made up Richard Tard, so if that's your name you can relax, but Mr Smith was real.

I always enjoy it when patients start in about their lawyers. It's usually before we've even talked to them. The best is when it's a psychiatric patient at two in the morning. I always make sure they get a phone. Please, call your lawyer right now. He'll appreciate it. He's just waiting for some manic drunk to ring him up and chew his ear for an hour or two. As for complaints in general, our director spends a great deal of time fielding calls from unhappy guests. We never hear about the calls from her because she knows that they're all whack jobs.

Getting back to the Tardster, after he was back in the treatment area I checked on him. I wanted to see how much trouble he was causing back there, but the person assigned to him said he was fine. He was just anxious, not accustomed to being sick, and she said she explained to him that his concern about other patients was misplaced. The guy who told him he had chest pain and was waiting ninety minutes had probably been there for five or ten. People exaggerate. So it sounded like all was fine with him, but then I had to take that report with a grain of salt. This was coming from a woman, a relatively new hire only a few months off of orientation, who wears weird crap in her hair. You know the kind of shit that black women put in their kid's hair? Yeah, that kind of stuff, only this is an adult white woman I'm talking about. I went back to my post.

It wasn't long after that when Mr Tard was discharged. He was back at the advocate's window chirping about his need for the official form to give to his lawyer Mr Smith. Like Mr Smith wouldn't know how to make a compalint on his own if he was bored enough to take this on. The advocate on the other side of the window was puzzled by all of this, he hadn't been there earlier so it was all new to him, and when he stepped away to figure what to do I intercepted him and gave a briefing on the earlier encounter.

It turned out to be easy enough to solve Mr Tard's dilemma. Security was called and he was shown to the door.

I had the good sense to keep my name out of this chart, so I'll never know if anybody received a call from Mr Smith.

Cheap Blade

I have a confession to make: I love food blogs. I think I read them more than I do medical or ER blogs. What I'm talking about are journals written by people who wait tables. I've learned a lot from them. For instance, I've learned that you can go into a restaurant, ask for water and lemons, and combine that with the sugar on the table to make free lemonade. Who knew? I also learned that what I was always taught was a good tip on a meal, 15% before tax, is an insult. Anything less than 20% after tax, no matter how execrable the service, is unacceptable.

The granddaddy of all waiter blogs is Bitterwaitress, home of the Shitty Tipper Database (STD). The STD is where waiters report back on tightwads and asshole customers. It's best know for reports on celebrity customers, many of whom are not only lousy tippers but are often completely unfamiliar with the concept of paying for the food, but it's also where the nonfamous can find their names if they're indiscreet enough to leave a less than 20% tip and/or act the ass in a restaurant when paying with a credit card.

Last year the site crashed and, although it's being rebuilt, all of the archives were lost. The single best entry I ever read there had to do with a certain celebrity named Wesley Snipes. It's just a classic description of an entitled person pushing it too far, and the ending is great. Although it's lost from the original source I managed to find an archived copy on the internet. In celebration of Mr Snipes' recent three year prison sentence for tax evasion, I'm posting it here:

This was a couple of years ago. I managed a popular nightclub in Vancouver called BarNone. On a jammin Thursday night in walks Wesley Snipes. We were pretty used to getting big names so he was not that big of a deal to us. He stayed for a couple of hours had two bottles of 93' Crystal , leaving a 9% tip. He first expected us to pick it up but I refused. Before he left I asked him if the service had been OK. He said that it had been great and asked why I had asked. I explained that I happened to notice the gratuity and that it did not indicate that the service had been good. I wanted to make sure it was. He left and came back early in the next week. He again purchased two bottles of Crystal or as he refers to it "Stal". This time he left a 6% tip. I again asked if the service had been there, he replied again that it was great. He then shows up two weeks later , again, early in the week. Oh and guess what? That's right, two bottles of "Stal". This time the jerk leaves 4%. Now, he has had the same server each time, she is a stellar server, big breasted, beautiful and incredibly intelligent. I know the service was awesome because I supervised it all night. So again, before he leaves, I ask him how the service was? But this time I do it in front of his whole group. He says to me, "Why are you always asking how the service was , it was fine!" I replied with , well sir, you have been such a pathetic tipper I thought it may be the service but now I realize that you are just a cheap bastard. He then says "How dare you......". I cut him off at that point and said "Listen Wesley , you either leave now , quietly, or me and my boys(several large doormen standing behind me after the yelling started) will Passenger 57 your ass!" Eat my shorts Wesley , I am a little girl Snipes.

While searching for the above story, I learned that Mr Snipes was so well known in the dining industry as a cheapskate that he has actually been denied service. That probably didn't have much of an effect on him, there's always someplace else to eat, but now he's stiffed the government and they've come to collect: three years.

Yes, he'll only serve a fraction of that, but still.