Feeding The Fantasy
“Hey girl! How you doing, Adrian?”
I turn around in that way that you do when someone has called you by the wrong name. I knew no one else was behind me. I also don’t work with anyone named Adrian.
“Oh girl, you’re so funny. I’m talking to you. Who knew Rocky’s wife has a sense of humor?”
“How’s he doing anyway? I can’t believe he’s got you workin’! But I guess it’s better than being a secretary. But it’s about time you did your woman job and give him some babies. A man that fine has gots to have some babies. What’s wrong with you?”
My woman job?
“I don’t discuss my personal life with my patients. How can I help you today, Janice?”
Janice began to speak and I use the opportunity to tune her out. My mind is processing about a billion things in a nanosecond. An inherent ability of all ER staff. I’m wondering how many of the Rocky movies she has seen? I’m guessing just the one. She’s clearly crazy mentally ill, a bit angry, and volatile. She’s also homeless. The positive luggage sign and distinct aroma are dead give aways. Do I tell her that I’m not Rocky’s wife but a nurse? What’s the best approach? Do I call for a psych consult? What’s the quickest way to get her out of the ER? I bet if I play along she’ll go AMA, she’s too angry to stay. Please don’t have a legitimate complaint. And she doesn’t but she said some magic words in triage (short of breath) which warrants a clean, dry, warm stretcher and a sandwich, an EKG which has lead her to me. Damn EKG.
“Ok, Janice. Let’s get you changed into this gown.”
“Now hold up, Adrian. I just got back here. Don’t rush me. Rocky has got his work cut out for him. I can’t figure out if you’re brave or stupid. I have to go to the bathroom, I’ll be right back.”
“Well, Janice. You came here for help (not to mention you passed 3 bathrooms on your way here) and I want to make sure you get help in a timely manner. We’re very concerned about your shortness of breath and EKG which means we’re concerned about your heart.”
“Well of course I’m short of breath, I can’t walk. And ain’t nothing wrong with my heart, either. You sure are stupid, Adrian. Can’t you see there’s nothing wrong with my heart? That’s not what I came in here for.”
Actually my xray vision is on the fritz, Janice, maybe Rocky can help me out with that? But instead of answer Janice, I provide her with a urine cup in the hopes that we will find something (legitimate) to treat. You know, to make her trip to the ER worth her while.
“Ain’t nothin’ wrong with my pee either, stupid bitch.” She takes the cup from me anyway and walks to the bathroom.
With Janice out of my sight, I’m able to think and process. I don’t even know where to start. Any attempts I make to address Janice’s issues are thwarted with ascerbic condemnations and dizzying digressions. How do I help her with the time I have? The resident isn’t having any luck, either. We’re stuck on a carousel. And I feel guilty for taking advantage of someone’s mental illness because (1) it’s the easier thing to do and (2) it humors me. And in the ER, we use any opportunity to leach out humor. So I don’t correct her delusion. She seems happy and cooperative there.
”Kill her with kindness,” I tell myself, “because killing her would be wrong.”
Once she’s back from the bathroom, I again ask her to change into a gown.
“Don’t rush me, I said. I just walked a long way and I can’t walk.”
Janice plops down on the stretcher in a life-is-exhausting huff and makes a move with her hands for her head.
“NO! NOT THE TURBAN! PLEASE DON’T TAKE THAT OFF,” I scream in my head. There’s no telling what was underneath her head wrap. Years of matted, gnarled hair? An infected abscess that emanates its own aroma and is sometimes accompanied by maggots? A sandwich? A ferret? No, for the love of olfactory senses everywhere, NOT THE TURBAN.
She was wearing a very stretched out v-neck. The turban would have fit through.
“Now how am I going to get the shirt off my head, then, huh?”
“You’re right, Janice? I’ll step out and give you some time to change.” And to my surprise, Janice’s head is clean shaven and without maggots, abscesses or ferrets.
“I didn’t say you could leave. Rocky really needs to beat some manners into you. I’m a victim of rape for 37 years and I know people who could use a good rape to set ‘em straight. Rocky will get right on that, don’t think just cuz he’s a fighter he won’t. So don’t go disrespectin’ me by doing things I didn’t tell you you could do.”
“Ok, Janice. Would you like a social worker or someone who can help you deal with your rape?”
“What would I want that for? Don’t be tellin’ me what I need? Rocky really needs to teach you how to talk to people. And you better listen.”
“Ok. I would like to draw your blood so we can run some tests for you.”
“I want 20 dollars for my blood.”
“Janice, this is a hospital. We don’t pay people to draw their blood.”
“You know, Adrian? I was really likin’ you til now.”
Janice stretched out her arm, pointing to the only vein she’d let me use.
”Hurry up,” she commanded me.
I finished drawing Janice’s blood and before I could secure her IV, she was snoring. Finally, the real reason for her ER visit revealed. And I was happy. Now I can get back to my patients who will let me help them.
Two hours had passed and traumas came, went and died. It is time for me to check in on Janice and draw some more blood.
“Janice, Janice,” I softly say in her ear as I have a hand on her shoulder.
“Huh? What the…..Who told you you could wake me up? I didn’t give you permission to wake me up.”
“Well, Janice, I have to draw another blood sample from you to send to the lab.”
“Nuh uh. You still haven’t paid me for the other bloods that you took. I didn’t come here to be taken advantage of and be disrespected like this. I’m a victim of rape for 37 years, I know what being disrespected is. You better back the fuck up bitch before I beat your ass. And I’ll do it to.”
If I had any belief in Janice’s words as more than just words and in Janice’s physical abilities (afterall, she couldn’t even walk), I would have called a Code Green. Instead, I reminded her that she came to me of her own free will and she could leave that way as well. I felt comfortable doing this for several reasons: her cardiac enzymes and BNP were negative, her chest xray was clear, she didn’t have a white count, nor did she have any open, weeping, infected skin sores.
“Well, Janice, if you don’t want to stay, you don’t have to.”
“Damm right I don’t. Get me my clothes you fucking whore. You may have married well but you let your career go to shit.” (This is my favorite comment from Janice that night.)
Janice left AMA, under the supervision of two of our finest deputies. As she walked away continuing to verbally berate Adrian, I was saddened. Our homeless is such an underserved, forgotten and abused population. Most are mentally ill, drug addicts or both. Most have been victims of crime. Most have a chip on their shoulder or carry a grudge. Most have more than one medical problem. Most exploit the very system that is designed to help them. Most want off the streets but our system is overwhelmed so they seek refuge in an ER if only to get a warm, dry place to sleep for a couple of hours, more if they’re actually willing to stay. Most lash out because it’s the only way they know how to communicate. I don’t take this personally. I just think what Adrian would have done. And I think she, too, would be saddened that she wasn’t able to help Janice. But like I said, how well can you really help someone in a nanosecond?