Maybe She’ll See

(Soon to be published in Emergency Medicine News   http://journals.lww.com/em-news/Pages/default.aspx )

 "She was dancing, you know, " grinned the EMS officer. She was strapped to a back-board, neck held rigid in the cervical collar. Her eyes with mascara and tears running search out the doctor with the grasping  need that goes along with having been taken away by the paramedics, attached to  a board and only able to look straight up at  the ceiling of the ambulance while one is delivered to strangers in the ER.

 Doc shakes her hand. " They tell me you fell off the pole on your head". The angry young man at her side wants to do all the talking for her. "Yeah Doc, dancin’, you know".

 Doc ignores him. "Let me talk to her, I need to hear what she says".

"Do you remember everything? Neck hurt? That could be dangerous, falling five feet off the pole straight down on the top of your head. Like diving into a swimming pool not deep enough. Hands, feet feel OK? Knocked out? Vomiting? We should CAT scan your neck-- lot of radiation, but in your situation, hurting your neck like that, scan is better."

"I'm pregnant"

"How far?"

"I think seven weeks"

"Well that early is certainly the worst time for X-ray, but the X-rays, like a flashlight are aimed at your neck, they can protect the baby with a lead apron."

The boyfriend, behaving more like her pimp , is  angry that he has been "dissed" and  that he's not in control of what's going on. "Shouldn't we just be talkin'  'bout her neck, she needs somethin' for the  pain,  man." Doc knows this angry young man has told her even before she got to the ER to be sure to ask for a prescription for pain pills. Vicodin is over five bucks apiece on the street. Doc has often not written Vicodin scripts for women with mysterious undiagnosable pelvic pain. No point in fueling the drug trade. But he knows many young women that he refused to write a script for are going to get a beating from the unseen boyfriend hiding in the waiting room, or the car in the parking lot, figuring on his woman making him a quick $100 on pills he can sell.

"Let's get her scan first", looking at this young man in the eye. The young man's gaze flickers away a second. He's not winning this intimidation contest. What a tough guy, only little boys abuse women. "It is my job to worry about the baby too. I need to talk with her--she is the patient." 

The CAT scan is OK. She is up and around, undoing the straps that had held her to the backboard.  Her breasts look like she had implants. An investment Doc guesses when you're a pole dancer. Was that his idea? Who paid?

"Take Tylenol only for pain, no Motrin or Aleve stuff like that--in fact don't take any medicine unless you check with your Doc first. Could be bad for the baby. You will be even more  sore in the morning in your neck, shoulders. But we really should stay away from the stronger pain meds." Doc looks directly at the boyfriend's eyes, he looks away. Tough guy. Yeah. No pills you can steal from her and either swallow yourself or sell. Not tonight.

 The RNs point him towards an older man struggling to breathe. Doc thinks to himself.  What if she was my daughter? Where is God? Why doesn't He stop this?  Maybe He is just incompetent, that is can't stop it. Why doesn’t He stop all of it? So much pain everywhere, everyone, especially in the ER after midnight. Perhaps He is just plain mean, likes to see all the suffering in His special little creations, rationalizes all the pain with that weak cover story about free will. Does He expect us to stop it? Doc sighs to himself “ I stop what I can.”

 Well, she will go home, knowing I spoke respectfully to her while standing up to that little boyfriend/pimp that wanted to do all the talking for her.  Maybe she'll see it can be done. Standing up that is.

 

- - Brad Cotton  MD, FACEP

( with thanks to Ernest Hemingway, a World War I ambulance officer who would have made a great ER Doc)