Portal de Periódicos da CAPES

Twisted Ankle While Dancing

2007; Elsevier BV; Volume: 49; Issue: 4 Linguagem: Inglês

10.1016/j.annemergmed.2006.12.018

1097-6760

David P. Sklar,

Emergency and Acute Care Studies

About a year ago, after a patient had a cardiac arrest in the waiting room, we decided to bring all of the patients waiting for care into a big open area of the emergency department (ED). It reminded me of a huge open pit mine with its bustle and unstructured space. We named it Flex, put a television in the room, and assigned a paramedic to keep an eye on things. We really had no choice; the main ED was often filled with admitted patients waiting for hospital beds that seemed to be less and less available. Some of the admitted patients would stay for days in the ED. We generally had between 15 and 20 of these patients filling our beds every day. Flex was supposed to be a place where patients could get their treatment started without having to wait for an ED bed to open up. We could order a radiograph for someone with a cough, start an IV, and give a breathing treatment. Metal chairs lined the walls of the room, which was divided into halves by a piece of temporary office wall material someone had picked up for 15 dollars. We were actually supposed to do our history and physical examination in a corner of the room—with a reclining chair and a curtain up for privacy—but it didn’t always work out that way. Sometimes the room in the corner was occupied or dirty. Then we’d try to ask a few discreet questions to the patients where they sat in a chair and maybe poke our stethoscope under a shirt to listen to lungs or a heart. Residents and faculty would often complain about the Flex area (and tried to avoid it if at all possible), but I generally supported the concept and thought we could make it work. Anyway, it seemed better than leaving the patients in the waiting room for hours. One day, I was walking into Flex to examine a man’s ankle. The chart said, “twisted ankle while dancing.” I thought it would probably be a good story, even if the medical problem were straightforward. The paramedic grabbed me as I walked by. “Doc, I’ve got a low glucose of 30 on this guy over here.” He pointed to a middle-aged man wearing a straw cowboy hat with a blue feather in the band. The man was watching Jerry Springer. The print at the bottom of the screen said, “Wife slept with son’s best friend, now she’s pregnant.” “Hmm,” I thought, “Where do they find these people?” Then turning to the paramedic, I said, “He looks pretty good—are you sure about the glucose?” “Checked it twice,” he said. “Is he diabetic?” I asked, wondering if he might have taken too much insulin. “I don’t know doc, I’ve got 30 people in here today. Look, all the chairs are filled up. I haven’t had time to ask him.” I looked around. The room was jammed. Kids were crawling on the floor. Crutches leaned up against the wall. The room smelled of french fries and ketchup, and I noticed the discarded McDonald’s bags under a chair. Every eye tracked my movement as they all glanced away from the television hoping that I might be coming to look for them. The man in the cowboy hat had a wispy black moustache and sallow skin. His eyes looked puffy and tired, as if he could hardly keep them open. The woman next to him was writing on a yellow pad of paper. She wore a blue denim jumper with a red and white flowered top. “Sir,” I said. “I’m the doctor. Are you diabetic?” “What,” he said barely opening his eyes. “Are you diabetic? Your sugar is low.” “Diabetic? Yes, I have sugar diabetes,” he said. “Do you take insulin?” “Yes,” he said. “Did you eat today after your insulin?” “No,” he said, “I was feeling too sick.” “OK, well, we need to give you sugar. Your sugar is too low. Is that OK?” The man looked at me and nodded. Then the woman in the denim dress looked up from her yellow pad. “Sugar,” she said. “You can’t give him sugar. He’s diabetic. It could kill him. Don’t take it,” she said. “Ma’am, are you related to this man? Is he your husband?” “Husband? Hell no, I don’t have no husband. He died.” “Well, but do you know this man?” I said. “I know him now. We been sitting in here on these chairs for the past 4 hours.” “Well, ma’am, what I mean is I’m the doctor, and I need to help this man. If you are not a relative, I’d appreciate it if you’d refrain from giving him advice. He needs treatment right away,” I said. “I may not be a doctor,” she said, “but I know a few things. I know you can’t give sugar to someone with diabetes. It’ll kill him. That’s why diabetics can’t eat donuts. That’s what killed my husband. He kept eating them donuts until his stomach exploded. Don’t take that sugar,” the woman warned the man in the cowboy hat. The man looked at me suspiciously. He reached up, pulled the brim of his hat down low onto his forehead, and stared at me through cloudy brown, bloodshot eyes. “Ya trying to kill me?” he said. “No, no, of course not,” I said. Now I noticed that they were fighting on the screen. Jerry Springer was trying to intervene as the husband tried to punch his son’s best friend, and his pregnant wife held the younger man’s hand. “It’s because you took your insulin, and you didn’t eat. That’s why your sugar is low, and if I don’t give you sugar, you’ll become unconscious and your brain cells will die. Your brain needs sugar.” “That’s the stupidest thing I ever heard,” said the woman. “I’m gonna write that one down so he can sue you for malpractice.” Now the other people in the room were watching us. Several of them nodded. “Yeah,” said a man wearing a Domino’s Pizza shirt, reeking of alcohol, “That’s damn stupid.” Now the paramedic was getting nervous. “Doc, maybe I ought to call security. They’re getting out of hand.” Then he turned to the man in the cowboy hat and said, “Look, the doctor here is trying to help you. If you all don’t cooperate, I’m shutting off the TV.” “OK,” said the man, “I’ll take the sugar.” I nodded to the paramedic as everyone settled back to watch and see whether the woman would go off with her husband or the son’s best friend. The woman with the pad of paper continued to write. I found the man who had twisted his ankle while dancing. He was a little man, in his seventies, in a green plaid polyester suit with white patent-leather shoes. “Hello, sir,” I said, “I understand you twisted your ankle while dancing. Could you tell me about it?” His eyes twinkled as he answered, “Some things just aren’t no one’s business, no offense to all these fine people here. But let’s just say it ain’t my ankle, and I wasn’t dancing.”