A day on call

Over here is a lady who can only communicate by sticking out her tongue. She has reverted to her child hood state and won't respond to questions in English. "Saco la lengua!", you command, because who knows if she's still alive? She sacos her lengua. Don't feel sorry for her though - she blew her own brains out high on a combination of heroin and cocaine and now she lies in a $10 000 a day neurosurgical intensive care unit bed, sucking on your tax dollars. At least, this is what my attending tells me.

Over there is a 15 year old, undergoing a tracheostomy cap trial. He has a big indentation in his head on the side his bone was removed in an effort to save his life. His crime? Playing basketball in a bad neighborhood. His mother found him, lying in the street across from his house, with a gunshot wound to the head. If he passes this cap trial, maybe that special rehabilitation facility that deals with pediatric neurosurgical patients will take him. He's failed three times. But he's been in the hospital for 80 days. What's another week while applying to a different facility?

I can see you in the face of your 95 year old aunt. She gets restless at night, calling out for your uncle, who's been dead for 30 years. This time she fell and broke her neck. You weren't there to prevent this, because although you try, how is it possible to watch her 24/7? You've fed her her meals, coaxing her to take a few more bites. You've bathed her. You've read the newspaper to her. How could you not? No one else will. I can see the scratches on your face, on your neck and on your arms. Last night she didn't recognise who you were and panicked, thinking you were a burglar. You still put her in her yellow dress and brought her to the emergency department though.

She told me she didn't use drugs. There are amphetamines in her urine drug screen, but that's ok. Maybe she ate an extra large bagel with poppy seeds on it. Oh wait, that's heroin that does that. We found out why her brain is so swollen though. She has had untreated high blood pressure, probably for many years. "Sign off! Let the medicine doctors deal with her. This is not a neurosurgical problem." That's my attending. He cuts to the chase.

Here comes the guy who fell down the stairs, drunk last night. He had bleeding in his brain and we asked him to stay in the intensive care unit overnight so he could be watched closely. We wanted to repeat his head CT in the morning. He had things to do at home though, *cough* get sloshed *cough* and left, "against medical advice". He's back now - on the ventilator.

Say, isn't that the woman who was just in the hospital last week for x? Now she has x AND y.

Don't worry, sir, we'll take good care of your mother.

Hey, mister, this won't hurt a bit.