The Mule

Revised version as it appears in Nursing 2012, November 2012 edition.



1993, New York.

The elderly Filipino woman was shaking when she was brought by the EMS paramedic to Triage. She clutched my hand, pleading in silence.

The EMS paramedic bypassed the other triage nurse and zeroed in on me, correctly guessing that his patient and I share the same ethnicity.

“We picked her up at the airport,” he told me. “Her plane had just arrived fromBrazil. The flight attendants noticed that she was very agitated and crying uncontrollably. It seems she’s traveling alone, but she won’t talk to us.”

Anybody’s grandma

She was in her late 60s, with gray hair and a stooped posture; she looked like anybody’s grandma. In fact, she looked a lot like my own departed grandma. She held tightly to her purse and her eyes filled with tears. My initial reaction was to pat her shoulder in a gesture of comfort. As I rubbed her back, I felt her tremble.

At that moment, two men in suits appeared and handcuffed “Grandma” to the stretcher. The narcotics agents informed us that she was suspected of swallowing condoms of cocaine and she had to be isolated from the general population. They planned to wait for her to pass the condoms. I hoped that the cocaine packets would remain intact. Rupture of the packets would result in severe intoxication, seizures, and death.

Her story was all too familiar. She was a drug courier—or, in the colloquial term, a “drug mule.” But she was much older than the couriers who’d come to our ED in the past. None of the other couriers I’d seen looked like “Grandma.”

In my naiveté, I wasn’t prepared to think of the possibility of my patient as a drug mule. As I looked at her in disbelief and disappointment, she averted her eyes. Thrown off by my preconceived notions of what a drug mule should look like, I couldn’t help but ask, “Why?” She kept her eyes closed, but tears ran down her cheeks.

The agents were frustrated with the lack of information. “We need to find the people who contracted her to carry the drugs,” they told me. Their interviews with the patient were met with silence. She looked afraid; she provided all the demographic data for the registrar but refused to give any contact information. Maybe she didn’t want to give any information for fear of repercussions.

Taking a turn for the worse

Suddenly she grimaced in pain as she pressed on her stomach with her free hand. Alarmed, I yelled for the physician STAT. The patient’s BP was rising and her heart rate was racing. I was afraid that the cocaine packets had burst inside her.

“How many packets did you swallow? Tell us, please!” The patient hesitated, but as she squirmed in pain again, she mumbled, “Ten.”

The next few minutes were frantic as we prepared to send her to the OR for exploratory surgery. We were racing against time.

As she was wheeled out of the room, she turned to me and said, “I did it for my family.”

No room for preconceptions

“Grandma” didn’t survive the surgery. As we later learned, she died because she needed money to pay for her daughter’s cancer treatment back home.

Although we’d expected it, the news of her death affected the ED nurses who knew about her story. Our stereotypical image of a drug mule shattered, we were also touched by her sacrifice for her daughter.

To what extent would you go to help a loved one? we asked ourselves. How tragic that our patient felt trapped by her circumstances and fell prey to the drug lords who took advantage of her need.

I learned an important lesson that day: No patient is stereotypical; as unique as we all are, we respond differently to the chaos in our lives. There’s no place for preconceptions in nursing. We should be able to rise above our personal feelings and take care of each patient the best we know how, without passing judgment.

My Favorite Things in the ER

I said I will only be staying for two years. Either I am a glutton for punishment, or just have an insatiable lust for adrenaline rush, or I really do love the ER. Twenty years later, the ER had taken a stronghold on me and I would never ever think of going anywhere else.


These are my favorite things:

1. EXCITEMENT GALORE- Nothing boring about ER. Every day offers something new and surprising, or out of this world. Days pass quickly, and however we try to manage our time, there's always something that needs to be done (including a bathroom break).



2. QUIET INTERLUDES, although infrequent, and temporary, are greatly appreciated and much-needed after a hectic day. Empty stretchers in the hallway are a welcome sight. This precious respite from the usual bombardment of patients allows time to sneak to the bathroom, catch up on each others' lives, and the chance to spend more time with our patients. Grab the moment to breathe because it means that a busload of patients are coming soon to break the peace.




3. HAPPY DRUNKS make up for the aggravation of having to fight off the nasty drunks. One day, a happy drunk masqueraded like a Luciano Pavarotti. His booming and impassioned O Sole Mio was surprisingly well-modulated and brought a smile to everyone, including our Alzheimer's patient, who stopped squirming in his stretcher. Somehow the familiar melody broke through the cobwebs of his mind, and he joined our happy drunk in total harmony.



4. LIVES SAVED We lose some, but most of the time we snatch patients from the brink of death. A 17-year old patient should have been a vegetable after a cardiac arrest, but we cooled him down and saved his brain. Five days later, he walked out of the hospital with full neurological functioning, ready to plan dates with his girlfriend again.



5. A SOILED METS CAP. A 9-year old boy felled by a direct blow on his chest from a baseball. He recovered from Commotio Cordis and came back to the ED to thank the staff. Pedro was in full Mets uniform, his blood-stained Mets baseball cap clutched in his tiny hands.



6. THANK YOUS.- A hurried discharge from a harried doctor left a patient and her family bewildered and frustrated. I spent just a few minutes to explain the discharge instructions. And I got a hug and a sincere thank you.



7. BULGING VEINS. Nurses always have a euphoric response to bulging veins, the ones which bulge before you even apply a tourniquet. No 22-gauge angiocathethers, no need for a vein probe, no need to call our vein expert. Just that quick pop, a gentle slide into a vein and Yes, you're home.




8. ELDERLY COUPLE HOLDING HANDS. The hopeless romantic in me triumphs at the sight of one elderly couple who held hands as they patiently waited for the ambulette we ordered to return them home. The husband comforted his wife with the sprained ankle. He catered to her unspoken needs. The wife soothed the husband who was getting impatient with the wait. I enjoyed watching them, even as I felt envious for the experience of spending a lifetime with a soulmate.



9. BABIES. Sometimes, babies are too eager to see the world and could not wait for the delivery room on the 5th floor . When the mother announces. "The baby is coming out!", the ED stops in anticipation and waits with bated breath. When the baby wails, the staff breaks into applause and coos as the baby is placed in incubator. Always a happy sight. We've seen enough deaths, so a new life reaffirms our purpose in being.



10. TEAMWORK. When the going gets rough, the ED staff gets going. Way past their scheduled off if the ED gets a call of a mass casualty. We trudged through several feet of snow, dodged drunks along the way, and stumbled through black-out streets. We held hands as we gasped in disbelief and watched helplessly at the horrifying scenes of 9/11 as played on tv. And then together as a team, we prepared the ER for the victims who never came. We hugged each other, and worked side by side to care for the rest of our patients.

ED ODD

As if medical stories are not weird enough: Harlequin syndrome, asparagus pee smell, brain surgery via the eye socket, jeggings and yeast infection, coffee-induced strangling, steak-caused positive drug result, 'hormone of love' or 'cuddle chemical', and "sphenopalatine ganglioneuralgia" or brain freeze.

And now, Botox to cure vaginismus? I guess smoothing wrinkles takes a whole new dimension,huh?



Truth is stranger than fiction, and it has never become truer than in the ED.


Patient: "An animal went into my ear, it's now in my brain."
Doctor: "What kind of animal will go inside your brain?"
Patient: "You're rude. My left brain does not want to talk to you."
Doctor: "Can you tell your right brain to talk to me?"


At triage...
Patient: "I looked at the mirror and saw a blinking eye on my left butt."
The nurse thought the patient was crazy, but the patient insisted in being examined.

So the nurse and the intern took the patient to the room and looked at the patient's butt in question.

An eye blinked at them.

On a trip to South America, an insect had burrowed itself on the patient's butt.
(story by D. Dillon)



It's important to follow directions.

A patient bought an over-the-counter topical genital enhancement product from a neighborhood store. He did not follow directions. Instead of just rubbing the ointment, he ingested two doses in preparation for a date. He did not know that the Atropine effects would make him very, very sick.

He died the day after.



Toxic Sock Syndrome- when your patient's socks had melted into the skin, and the smell travels all the way to the hospital lobby. The patient is oblivious to the suffering around him. The staff tries to hold their breaths and waits anxiously for their shift to end.




Toxic Tampon syndrome- when a first-time user thought the tampon will absorb on its own.

SURPRISE!!!

Expect the unexpected. Brace yourself for a day of wonderment and what-the-hecks... of jaw-dropping and head-scratching incidents that defy explanations. You think you've seen it all?

Surprises abound in this place. And we love them. Not a 9-5 job where you can pretty much expect how you'll spend your day.

Huh, Welcome to our Emergency Department.


At triage...
Patient: "I swear I'm not pregnant. Shouldn't be. I'm on the pill. But my belly hurts soooooo much!"
Nurse: "Let me just put you on the stretcher."
Minutes later, the patient screams, the nurse lifts up the sheet, and finds a baby on the stretcher.
SURPRISE!!!


Nurse: "Miss, can you please give me some urine for a pregnancy test?"
Patient: (Giggles) "You're so kind. I'm really a man. "
SURPRISE!!!

Nurse: "Your son just went to x-ray, ma'am".
Woman: (outraged) "Excuse me, that's my husband."
SURPRISE!!! (awkward, too)


Undressing a homeless patient then finding wads of twenty-dollar bills tucked away in his underwear. Total amount = $10,000.
SURPRISE!!!


Foreign body in rectum, all types, all sizes.
SURPRISE!!!



December blizzard 2010... EMS brought a patient on a sled.
SURPRISE!!!



Patients help each other. An intoxicated patient was carried into the ER on a grocery cart by a similarly-ETOH intox friend.
SURPRISE!!!




The nurse heard grunting from the other cubicle. Thinking "Molly" (one of our ER alcoholic regulars) was in pain, she drew the curtain. Molly and her boyfriend were in a compromising situation. So much for privacy.
SURPRISE!!!


http://nurses.definitelyfilipino.com/index.php/2012/03/surprise/

Goodbye, Kettly

Emergency Department... a place where we see deaths up close and personal. The ED staff who choose to stay do so because they love the rewards that come from saving lives. We are hardened (crazy) souls who have accepted life's realities. But it is difficult when you lose one of your own.

Today, we said goodbye to Kettly.

Through life’s ups and downs, Kettly managed to smile her way into her fellow nurses’ hearts. She reveled in the deep friendships that blossomed amidst stressful times in the ED. As she struggled with illness, she persevered and impressed her hospital family with her indomitable spirit of resilience and tenacity. Her easy wit and sense of humor brightened our days as we all commiserated with each other at the end of each day. Kettly cared for her patients, even as she needed caring herself. She offered hope.

It is difficult to imagine that the once-vibrant nurse who delegated cooking duties like a drill sergeant for the holiday party is no longer with us. Could she have been preparing us for her untimely passing by creating special memories of friendships and by showing us the value of team work? Did she realize that the new triage nurses would remember the words of encouragement she gave them on her last day in the unit?

As she held her family in her heart, she reserved a special place for her hospital family.

Last night, we gave Kettly a White Rose tribute and showed our appreciation by honoring her with our Nursing flag. The nurses, all dressed in white, stood en masse in solidarity with a few of our colleagues who struggled to read lines from a poem written by another nurse:

To witness humanity—its beauty, in good times and bad, without judgment,
She was there.
To embrace the woes of the world, willingly, and offer hope,
She was there.
(“She Was There” is copyrighted by D. Jaeger)

Kettly, we will miss your carrot cake, your de-boned turkey, and your words of wisdom. But most of all, we will miss the nurse who showed us quiet strength and resolve through adversity. We will miss your regal presence.

Alone On New Year's Eve

New Year’s Eve,New York

"Jenny, please, can you come in to the ER?". An urgent call from her frantic supervisor roused Jenny from her bed and derailed her New Year’s eve plan to brave the throng of New Yorkers in Times Square to witness the ball drop with her friends.

Jenny was supposed to spend this New Year’s Eve with someone special. She thought that Reese would break through the defenses she had put up, but just last week, she finally conceded that their relationship was not meant to be. Dr. Reese Walton had pursued her for about six months, but it looks like he had just given up. Maybe he could not understand her reluctance to open her heart again. Just when she had decided to accept him, she heard that his ex-girlfriend had claimed his attentions again.

Her whole family lived far away in the Philippines, so she always made sure that she spent the holidays with friends. They were all in their mid-twenties, all single and enjoying the freedom of youth. The pangs of homesickness are better dealt with when amongst friends.

Two of her co-workers had figured in a minor accident but would not be able to make it for their shift. And since she was single and lived alone, she was the most obvious choice for her supervisor to cajole into submission.

Jenny, once again, was alone on New Year’s Eve.

At 5pm, the Emergency Department was bursting at the seams. The masses had descended upon the ED with a spectrum of complaints ranging from the minor in-grown toe nail to the major gunshot wound traumas. Patient volume was high; there was no open stretcher in sight. It used to be that the presence or absence of stretchers lined up in the hallway leading to the ED spelled the difference whether the ED staff would have a good day or not.

Well, it looked like the neighborhood drunks decided to spend their holiday in our ED. Free meals, a clean stretcher, and an occasional smile from a pretty nurse. And a chance to blow off the excess alcohol through their system, out from the cold winter streets, in the sanctuary and warmth of the ED.

Jenny had often joked that one can get drunk passing through the hallways, just from breathing the off-gases from the inebriated patients as they kept a cacophony of snores through their stay. The nurses had given up trying to undress these patients; priorities made them concentrate their efforts on the truly sick, especially when they’re two nurses short. And besides, all that was needed was time… when these patients wake from their drunken stupor, they demand to be released back into the streets. The ED was a merry-go-round for those who cannot get rid of their addiction to liquor.

A patient caught Jenny’s attention. He was usually a happy drunk, not shy in expressing his appreciation to the female form by way of wolf whistles and suggestive remarks. Now, he laid back on the stretcher, and accepted the intravenous with no protest at all. Jenny whipped out her ever-present penlight and shone it on the patient’s eyes.

A frisson of fear snaked down Jenny’s spine as she saw the unequal pupils, one sluggish and dilated. True enough, a quick CAT scan revealed a huge subarachnoid bleed. The patient was quickly rushed to the OR. Whew, another life saved. But looking at the mass of humanity in the crowded waiting room, it would be back-breaking work for the personnel of this busy New York City ED.

Resigned to the long night ahead, Jenny worked with the other triage nurses until at about 1000 pm, all was quiet in the triage area. The EMS crew had hunkered down to their station to watch the ball drop…until the next 911 call.

A transport clerk brought an old woman to the triage area. Denise guided the woman to a triage chair. “I found her wandering in the lobby. Couldn’t understand what she’s saying.” She whispered to Jenny, “I can smell alcohol on her.”

The woman looked Asian, probably in her 70?s. Clutching a big bag close to her chest, she shook her head when Jenny asked her questions. She was well-groomed with sensible shoes and a thick wool coat, but she was reeking of cheap beer. With tears in her eyes, she presented a worn picture to Jenny. The sepia picture showed a young couple holding hands amidst a backdrop of what looked like a Chinese temple. The woman was dressed in a dark-colored cheongsam, while the man‘s attire looked like a loose-fitting, light-colored shirt with an upturned collar.

Jenny commandeered a Chinese doctor to interpret for the patient. When asked about the alcohol smell, Mrs. Chen looked embarrassed but finally admitted that she bought a pack of beer from the grocery so that she can sleep through the night. She spilled the first can of Heineken all over clothes. She started to feel dizzy, so she decided to leave the pack of beer to a group of homeless men on the streets. But she felt disoriented on her way back home, and was then picked up by a passing EMS van. She managed to get out of the guerney and walked out to the hospital lobby.

According to the translator, the woman’s husband of 55 years passed away about six months ago, and she lived alone in her house. Mrs. Chen had always been independent but during the holidays, it had been their tradition in their close-knit family to spend New Year’s Eve together. Mrs. Chen had expected a call from her two children who lived in New Jersey, but when no call came, she decided she did not want to spend her New Year’s Eve alone.

The woman continued to reminisce about the good old days with her husband, and she started to cry miserably. Her sobs filled the small private room. At that time, the doctor was called to the Trauma Room, and Jenny was left alone with the woman. Unable to comfort the woman because of the language barrier, Jenny just patted Mrs. Chen’s frail shoulders. Jenny knew too well about holiday blues.

Because there was no social worker on duty at that time, the hospital administrator volunteered to find help to locate Mrs. Chen’s family. The patient could not remember her children’s and friends’ phone numbers. At that time, it looked that she needed to remain in the ED.

It was already 11:30 pm. Almost time for the ball drop. The table at the employee lounge was heavily laden with ethnic food and the TV played the pre-show celebration in Times Square. There was excitement in the ED; half of the staff gathered in front of the TV to wait for the countdown. No EMS crew stayed around. All the admitted patients had gone up to their floor beds. The doctors had discharged most of the patients, except the drunks… and Mrs. Chen.

The administrator brought back the good news that NYPD had gotten Mrs. Chen’s family’s telephone numbers. They had been frantic to locate their mother who had initially told them that she was spending her holidays with friends. The sons would be coming to pick up their mom after midnight. Mrs. Chen looked relieved that her family had located her, but admitted her disappointment that she would be away from her family at midnight.

It was Jenny’s meal break, and she should have been in the employee lounge joining the festivities, but she took two plates of food to share with Mrs. Chen. She did not want Mrs. Chen to spend New Year’s Eve alone. Two other nurses followed her to Mrs. Chen’s room. As the TV screen in her room displayed the revelry in Times Square, Mrs. Chen happily ate the food that Jenny brought.

11:59 pm. Sixty seconds to go and the glittering Waterford crystal ball had already started its 77-foot descent. Mrs. Chen clapped her hands in delight as the nurses counted down.

“Ten…nine… eight… seven… six… five…four… three…two… one. Happy New Year!!!!”

Jenny hugged Mrs. Chen and pretended she was her mother back home. A flood of emotions gripped Jenny as the two women shared their loneliness. The older woman reminded her of her mom- talcum powder and cooking oil.

Jenny missed her mom terribly and wished she was with her own family celebrating the season noisily as her big family always did. Their house would have been filled with relatives enjoying a sumptuous meal after a night of fireworks display. The Filipino New Year celebration was always boisterous. It is during the holiday season when Jenny feels homesick for the familiar comforts of home.

The old woman’s eyes filled with tears, but she was smiling this time. “Xie-xie”. Thank you in Chinese.

Jenny was thankful for the chance to help Mrs. Chen, and for, even for a minute, just be able to hug someone who reminded her of her own mother. She didn’t spend her New Year’s Eve alone after all.

She responded with “Salamat po.” Thank you in Tagalog.

Happy New Year!

A new year had just begun. At one o’clock in the morning, Jenny made her way to her car, resigned to the idea of spending the first day of the year sleeping off the loneliness.

Reese came up behind her, armed with a bouquet of flowers.

“I’ve been calling you since last week, Jenny. Why are you avoiding me?, he sounded tortured.

“Just leave me alone, Reese. Stay with your ex.”

At the confused look on Reese’s face, Jenny exploded in anger and recounted all the stories she heard of the reconciliation between Reese and his former girlfriend.

Reese vehemently denied all her accusations, and proclaimed his love for Jenny. It was there in the middle of the deserted parking garage, with fireworks in the background that he hugged Jenny tightly. His voice quivered when he said, “Believe me, Jenny, it’s you who I love.”

Here was a man, successful in his career, with everything going for him, but he laid his heart open to her. Jenny hugged him back, and with tears in her eyes, kissed the man she loved.

She thought, I’m not alone after all.






* not her real name

Dog in the ER

“Woof!”

I am hallucinating. That couldn’t be a dog who just went through the revolving door of the ER and is now just outside my triage booth. No way!

The Waiting Room in the ER was quiet; at 3am, only the sickest of the sick venture out, and most come via ambulance. Adrienne had finished triage for all her waiting patients, and now the waiting room is like a ghost town with just a few family members staring blankly at the plasma tv screen.

Adrienne prefers being in the middle of the action in the Cardiac and Trauma Room. With nothing to do at External Triage, she was trying to stay awake through the questions for her nursing certification review. The coffee didn’t help; the words swam before her eyes.

“Woof! Woof!” The insistent barks pierced through her consciousness.

I’m not hallucinating. It really is a dog!

“Hi Adrienne! Is that your dog right outside your booth? ” The clerk came back from his break and saw the little Yorkshire terrier.

“Bill, I don’t know whose dog this is. I just saw him go through the door, right at the time when a patient’s family member went through.”

“Really? Are we accepting dogs now in our ER?”

Curious, Adrienne got out of her booth. A dog lover, she felt comfortable enough to approach the strange dog with the puppy eyes. The dog’s blue-black and tan coat was silky and appeared well-groomed; obviously not a stray dog. The dog whimpered as if in pain, and he shifted his weight off his right leg. Adrienne squatted down in front of the terrier who accepted a pat on the head.

Bill’s inquiries with the occupants of the waiting room were met with more blank stares. The dog didn’t belong to them.

Adrienne noticed streaks of blood trailing from the ER entrance to where the dog was sitting. Lifting the dog’s right paw, the triage nurse saw a piece of glass sticking out from the lateral aspect of the terrier’s right paw.

There was no other choice but to bring the dog to Fast Track. The medical resident on duty took one look; not his usual patient but he ushered the dog to a patient bed. Surprisingly, the terrier appeared to accept all their ministrations with just a soft whimper, but did not attempt to bite anybody. Two physician assistants held the dog as the medical resident pulled the offending glass.A quick wound clean-up was followed by a bandage on the dog’s paw.

Maybe as a thank you, the dog licked the hands of everybody in Fast Track. He happily accepted a piece of Adrienne’s hamburger.

Bill later reported that he could not find the dog’s owners either outside the ER ramp and entrance. The administrator volunteered to notify ASPCA, as soon as office hours open in the morning. Several nurses and PAs volunteered to take the dog home while the owner is being located.

The nurses named the dog Andrew in honor of the medical resident who removed the glass on the dog’s paw. Andrew the dog went home with a physician assistant. Sadly for Rochelle’s three young kids, the dog was reunited with the owner three days later.






Based on a true story.