On Friday, the first night after Thanksgiving, the annual epidemic of wheezing infants and vomiting, gastrointestinally-afflicted children failed to materialize. Instead, at 7 PM, shortly after my shift began, a greenish 15-year-old was wheeled into the crowded Pediatric waiting room and puked, sending toddlers and already disgruntled parents flying. The treatment area was already packed and no one would be getting in to be seen for at least another half-hour. I had gone to the waiting room to scope out sick kids to get their evaluation started, but went straight to this newest arrival. The nurse wheeling him in had completed a triage sheet, showing a lowish blood pressure and fastish heart rate.
“Hey folks,” I announced, “I’m the doctor tonight, and I hate to make you all wait even longer, but this guy needs to come right back. I’m sorry, and I’ll try to get to you all as soon as I can, but this guy’s gotta go next.”
To his parents, as we wheeled into the treatment area, I said, “He’d better have appendicitis or something worse, because I just put myself on the line with all the folks out there. And all the nurses in here.” The kid himself obliged. “Dude,” he told me, “I’m—” and then retched all over his feet.
The Pediatric section has 11 beds in an ER that can hold another 40-some patients, plus a dozen or so more unofficial slots along the hallways when needed. Like the roads and shopping malls that day, every square inch was occupied. Very few patients were actually emergency sick. The adult patients, like the children in my charge, were mainly present for the reassurance of a blood test or radiologic picture, and the balm of a bottle of antibiotics. We were not quite at overload, but our patient population has a tendency to panic at any symptom, and I couldn’t help but feel that we shouldn’t be so close to that point, either.
The first batch of kids, from 7 to 11 PM clustered in the 2–4-year-old range, with an equal mix of earaches, vomiting, and fever. The exception was a hulky 15-year-old who had collided head on with another 15-year-old at football practice and left a dent in the school turf. He sat in his stretcher, half-leering at our blonde tech showing off her low-back tattoo, with his dad glowering. When the dad, a solid special-ops looking kind of guy, caught my eye, he planted himself straight in my path.
“When are you gonna scan my son?”
I hadn’t even been in to examine him, but several things were immediately clear:
The dad had no interest whatsoever in my clinical judgment regarding his son.
The son had no risk whatsoever of anything more serious than a minor head bonk.
They had insurance.
There were more important things for me to do than fight this
I was gonna get the CAT scan they wanted.
I sized up the dad again and told him, “Already in the works, chief.”
11 to 1 AM saw an all-ages mix with a hint of croupy 3-year-olds and all my CAT scan reports came back. The greenish 15-year-old turned out to have appendicitis, the hulky football player had, as the radiologist called it, a “negative brain.”
Football-kid went to the same school as appendicitis-kid, and told him, “You look pretty wrong.” Appendicitis-kid-dad told football-kid-dad, “That doc got me back here right away.” Football-kid-dad told appendicitis-kid-dad, “That doc wasted my whole fucking night.” Appendicitis-kid told football-kid he’d been watching 8 Mile when he got sick.