He’d found a spot in a chair along the back wall around the corner, out of view of Mission Control, away from Triage, away from Fast Track. There wasn’t anyone else near him outside of the treatment areas back there.
We’d just gotten through a mini-surge, and with that, there could have been several greens or blues or burgundies go right by him assuming he was there to be with someone. And maybe that patient was off to radiology or somewhere else for tests.
I might have walked right by him myself, on the way to my break, eyes nearly closed as I went to the Den for a quick refresh.
“Hi sir, how are you doing?”
He said he was fine and asked how I was doing. No alcohol on his breath and he smelled clean, recently showered. He was dressed in khakis and an unironed button down. Shoes with laces. He’d taken the time to get ready to be here, hadn’t just thrown on a bathrobe and watered down his hair. And he wasn’t looking for attention. He didn’t have a wristband.
“Are you waiting for someone?”
“Yes.”
“Okay, just sit tight. It won’t be long now. I can check how it’s going. What’s the name?”
He gave me a name. I asked if that was the patient’s name or his and he said both.
Back at MC, I checked out the name. It was a real one, someone in the system but not yet routed through the big desk. That’s when I realized what should have been obvious. He was the patient.
Occasionally someone gets through. I won’t say it happens a lot but occasionally. People with imaginary, unverifiable symptoms. People hoping to get the drugs. Wanting the attention.
And that’s completely different from the people who have legitimate reasons for coming in, made the right decision to do so, but the diagnosis ot what they feared, and their symptoms easily addressed. That’s a decent amount of our traffic. The problem there is that moves the patient to a less urgent status which slows everything down. Those patients wind up spending most of their time here waiting for a doctor to sign off on their release.
But this man didn’t seem like any of those people.
He’d was checked in by Admitting in at 3:46 am – an hour and a half earlier! The notes said he’d fallen at home and felt disoriented and didn’t know where else to go at that time of the night or morning. He wasn’t sure if he’d hit his head or not.
With that, N. Renwick booked him, coded him to the non-emergency emergencies and at some point, someone from in here went out and got him and brought him back.
I slipped out to the waiting area to see Naomi, glad it was her. Not a stickler. Not a burnout. Someone I could talk to about him without her reaching for the security button.
“Oh yeah, is he still back there?” Naomi asked.
“We never got him. Looks like he never checked in. So he’s not in the lineup. The notes say he fell?”
“Yes,” she said, looking at his record on the screen. Even with work buddies, you learn to tell one story around here. If someone asks what you wrote you don’t do a recap, you look it up and read it back. It was the same thing I’d read myself a few minutes earlier.
“Patient fell. Concern over possible head trauma. Patient shaken.”
And that’s how his name, to me, became Mr. Shaken. We do that. Give people names. Although, however shaken he might have been coming in, he was, at least on the surface, pretty leveled out now.
Did you see who brought him back?” I asked.
“Our baby, Cline.”
Who wasn’t a baby or noticeably younger than Naomi or me, but Naormi calls everyone in our break bunch “our baby.”
“Oh my God, is he still here?” Cline asked when I found her a few minutes later.
“He’s around the corner by the Den. We don’t have him at MC.”
“Ugh, I’m sorry. I’m so so sorry, boss.”
“It’s okay, Crazy night and he’s fine.”
“There was a pileup at the desk and I thought he should be seated. I gotta buzz and he asked about using the restroom. He must have gone to a different seat after that. He wasn’t a mess. I guess I thought someone took him or that he just went home.”
“It’s alright. We haven’t lost him and he isn’t causing a fuss. I’m going to try to get him out of here before someone wags a finger in my face.”
“I’ll go check on him.”
“No, I’lll go. If you go, it really will look like we forgot about him.”
Before returning to him, I checked his full history. He had been in the ER a few times over a span of a couple of decades but there weren’t any flags. He was no frequent flyer, no pillhead. Flu on the weekend once. One bike riding accident. Nothing unusual on his overall chart for someone his age. He was older than he looked. Up to date on checkups, blood work, vaccines, colonoscopies, PSA tests, stress tests.
When I went back around the corner, I was prepared to see an empty chair, him gone, having fled upon being discovered. But he was still there, looking down and away. When I sat next to him, he stirred like he’d been asleep but I think he was just zoned out.
I put it in my mind not to talk down to him. I see that so often with older patients here, nurses and techs speaking louder and slower, nodding as they spoke as if to try to hypnotize the man or woman into thinking they understand what’s going on whether they do or not. I can’t stand that. Show some sympathy, yes, but who likes being treated like a child? I wasn’t going to do that here.
Except, I almost called him “Mr. Shaken.” Really. I got as far as “Sh-” which isn’t the beginning of his name. I reset, then said, “I’m Donna. How are you feeling? Any headache or other soreness? Your chart said you fell? And you hit your head?”
“Yes. That’s the story.”
He then looked at me and focused on me. It was a two-stage thing, looking then focusing.
A gurney went by, someone headed to radiology. Nurses and techs were hustling in both directions. Doctors came through, the moment the patients had been waiting for. Most of the time, they only needed a few minutes per patient because of everything else that had already been done by everyone else.
He watched the comings and goings like it was a performance.
I read the look on his face, leaned in, and said quietly, “I have to ask you something, and it’s ok. Did you really have a fall?”
A start of a smile appeared on his face then vanished.
“Tell me. Why are you really here?”
His head dropped for a few seconds, then he was looking at me, and said, ““I was scared.”
I nodded and gave him a moment. “Okay, you came here because you were scared.” A statement, not an inquiry.
“Yes.”
His eyes – he wasn’t about to cry but there was something deep in there that he was trying to communicate. That he wasn’t a fool. That he didn’t want to be a problem.
He was just scared.
“I was scared. I couldn’t think of anywhere else to go. This time of night.”
“Did something specific frighten you? A bad dream or noises or something?”
“I keep trying to think if that was it.”
“Did you almost fall? Lose your balance?”
“A little.”
“Mr. —, is someone hurting you? Are you afraid of someone?”
“Oh no no no. Not at all. Really, please, not at all.”
“I’m sorry but I have to ask questions like this. Are you alone at home?”
“Most of the time.”
“And I see by your chart that you live pretty nearby.”
“Yes.”
“How are you feeling now? Does it help being here?”
“It does. Thank you.” He said that like he wanted me to feel better.
I asked him to wait and told him I’d be right back. It wasn’t because I had to think about what to do next. It was to validate the notion that I was treating him like a normal patient. Other nights, if things were flying and doctors and nurses and patients were all being numbskulls, I might have wrung his neck.
Again, I thought there was a possibility he’d be gone when I went back to see him, but he was still sitting there, now leaning back against the wall but eyes open.
“Okay, well, here’s what we can do next. Since you never checked in with us, you haven’t officially been admitted.”
“I checked in at the front desk.”
“I know, but we never got you at our desk in here and that’s where we figure out what kind of doctor you might need. That’s where you would have gotten a wristband.”’
He looked at his wrists as if surprised he didn’t have one.
“But now, what that means is that since you were never admitted, we don’t have to wait on a signature for you to be discharged. I could put you in the system now, and get you in line for a doctor to see you, but that starts the wait all over again.”
He nodded again.
“So you’re free to go if you’d like, but I can’t just let you get up and walk out.”
“Okay.”
“Things could start ramping up soon. Is there any family we can call to come get you?”
“I’d rather you didn’t.”
I suspected that would be the response.
“Would you mind waiting another half-hour or so?”
“I can do that.”
“And you live in the big complex across the street?”
“Yes. A long time.”
I repeated that I couldn’t just let him walk out and asked him again to stay put. I went to find Cline then went back to him. He was still there.
“I have a friend here that goes that way and she’s got a little ways to go with her shift. If you can just wait a little longer, you two can walk out together.”
“Okay.”
“Okay. You hungry? Want some water? We’ve got snacks and things, crackers and cookies and stuff like that.”
He chuckled and said he’d like that.
“Okay, I’ll send some over. And your date is Nurse Cline. You’ll recognize her. She’s the one that brought you back here.”
“Oh yeah,” he said, and put his hand out palm down at the height of his own head while sitting down, in an approximation of Cline’s height. That got a chuckle from me. He didn’t add any hand motions indicating her roundness.
“I have to say one more thing. I understand why you came, but you can’t make a habit of this. Maybe give your doctor a call tomorrow. You don’t have to tell him you came here. Get ahead of it in case it happens again.”
“Her.”
“Huh?
“My regular doctor is a woman.”
He asked me my name again.
“I’m Donna. Nurse Cline will be here in a bit. Sit tight.”
I had an intern take him water and snacks. She came back empty-handed so he was still there. She didn’t act like anything unusual was going on, like there was anything curious about him or there was something she wasn’t being told.
Cline stopped by before going to him.
“Thanks, sweetie,” I said. “Can you take him out our way instead of the front? And I think you can just get him to that side entrance gate to his building along First Avenue. Maybe kinda peek back to make sure he gets to the lobby but don’t go with him all the way there.”
“I know, I know. Don’t act like he just got out of the hospital. You think he’s okay?”
“He seems so. It doesn’t do any good for him to be here any longer, I know that.”
“Yep. Got him. See ya next.”
She didn’t bring him out past me. They must have exited through the main hospital.
I went back out to Naomi.
“Let’s mark him LWBS (left without being seen) on your end. See if we can keep him from getting a bill for the copay.”
“Yep, got it. So did he fall or not? Why did he come in here?”
“I asked him. He said he was scared.”
“Scared?” Naomi asked.
I nodded and shrugged.
“That’s what he said. He said he was scared.”
“Scared? Scared of what?”