The thing about working in the ER is that at some point you kind of feel like you live there. You’re there at all hours of the day and night, weekends, national holidays, birthdays, etc. You see the same faces starting from the security boys to the orderlies, nurses, cleaners and of course the doctors. You also see the same patients over and over again. Every hospital has a collection of customers that seem to also think of it as their home. They’re there at all hours of the day and night, weekends, national holidays, birthdays, etc. The know which nurses cannulate the fastest, they know which doctors they don’t want treating them: ‘Oh God, it’s that Sudanese girl again, no morphine for me this time.’ They know the shift in charge by name. They know the doses of the medications and even correct the junior doctors sometimes. They even get invited to staff occasions, like food fairs and weddings. There are old men neglected at home who come for a little TLC, there are drug addicts coming for their fix and are willing to wait outside all night to get it. There are alcoholics who keep falling off their wagons again and again. There are psychotic patients who won’t take their medications and keep relapsing. And there are unfortunate children with stupid parents that either don’t know how to take care of them or don’t want to take care of them and drag them to the ER twice a week for a runny nose or a rash they’ve had since birth. And there are people like Zainab.
Sometimes I think we do more damage to people than use. Like this girl Zainab presented first with a urinary tract infection and a year later had a diagnosis of Parkinson’s, motility disorder, hypocalcemia and vitamin D deficiency and hypothyroidism. Now she has to be catheterised because she can’t urinate herself and keeps going into retention. She has also has chronic constipation and the only motions she passes is when her colon is so loaded it overflows. She is depressed, smells bad all the time, has lost weight and has the worst possible parents someone in her position can have. I still don’t understand how she deteriorated so much in such a period. When I saw her a year ago she was just a shy, slightly subintelligent girl of 19 who had a problem going to the bathroom because it burned. Bit by bit she stopped going to the bathroom at all. Her parents brought her 3 times in one week and couldn’t understand the concept of actually taking the medication prescribed and giving it more than 24 hours to work. It was so irritating. However, things just got worse for her. Eventually an Xray showed that her colon was so loaded with faeces it was pressing on her urethra to the extent that it was blocking our urinary outflow.
From there things just kept getting more complicated. In the months before then and last week I was lost in my own adventures: numerous exams, sudden richness and just as sudden bankruptcy, a short-lived engagement and an eventual breakup, as well as other dramatic events that kept me oblivious of my surrounds. I saw her last week and didn’t even recognize her at first. She was so thin, exhausted and just plain miserable. She looked sweaty and her clothes were hanging on her. She was in pain and crying because her bladder was so full and she couldn’t pass a drop. And her mother was holding her by the arm and dragging her along. She was treated that day and discharged and came right back again the next day. Another XR, probably the 9000th she’s had this year alone, showed as usual an overloaded colon. I was standing on the other side of a wall separating her cubicle from the corridor, and from there I could hear her crying that she didn’t want an enema or a manual evacuation the second she heard about the Xray findings. I could hear her parents hissing at her and telling the doctor to just ignore her and do whatever they want. And I heard the slaps and her screaming, and her father damning her and her obstinate idiocy. I couldn’t handle it and walked away.
My heart breaks to see people that have to turn to an ER for the comfort they can’t find elsewhere. Every time I see that 80 year old man who lives alone and has so many children but no one to take care of him I curse the fate that handed him such thankless beings. Every time I see the SCD patients who are hooked on the narcotics they’ve been fed since they could walk I wish such things weren’t even invented. Every time I see Farid crying in his cubicle from the abdominal pain and the shame that he had again lost his fight with the bottle I wish I could find that part in his brain that keeps dragging him back to it and cut it out. And when I see Zainab in all her endless misery with parents who are sick and tired of bringing her back and forth every day and having to explain her embarrassing condition to people, I wish I lived and worked somewhere where I didn’t have to know about her and people like her.
Perfect health and loving family are so underrated.