Portal de Periódicos da CAPES

A Monkey Could Do This Job!

2007; Lippincott Williams & Wilkins; Volume: 29; Issue: 1 Linguagem: Inglês

10.1097/01.eem.0000264636.46323.52

1552-3624

Edwin Leap,

I have to come clean. I carry a terrible burden, and I can no longer hide it from you, my faithful readers and friends. For several years I have been involved in a government-funded project to establish emergency department staffing in case of a global catastrophe, like an epidemic of lethal pandemic avian flu. The research group has been worried that in case of something like a pandemic, we'd all drop like the proverbial prom dress, and those who didn't drop would probably stay home eating canned soup, playing Xbox, and looking forward to lots of cheap estate sales. The truth is that there are only so many people trained to do what the nurses, paramedics, and physicians do in emergency health care. And there are only so many who can work under conditions of extreme emotional duress. The solution our study group developed will shock some and encourage others, and may even rock the world of health care recruiting. One word: chimpanzees. It would take a very long time to describe the research so I'll give you more than an abstract, less than an article. Chimpanzees chosen appeared compassionate toward other animals and humans. They were trained from a young age in what we called “The Residency,” a facility with computer simulations, mock patient rooms, and lots (and I mean lots) of fruit. These chimps were taught advanced sign language and recognition of simple phrases common in the ED. They were exposed to hours of video involving simulated patient encounters. The chimps were then taught basic skills, like how to stock items by shape and color, how to remove patients from cars and move them onto beds, how to empty bed pans and urinals and change linens, and how to clock in late and defend their actions. An interesting thing happened. Many of the animals sought out opportunities to do more. They began to insert IV catheters in one another, which was fascinating except for the one who injected fentanyl into his lab partner, who subsequently stopped breathing. It was then that we realized they could easily perform CPR, and training was initiated. We also noted that humans had lost a lot of skills, and after much investigation, we discovered that the chimps could detect illnesses by smells or pheromones, tones of voice, repetitive patterns of behavior, and signs and symptoms consistent with certain illnesses and injuries. Lacking the obvious advantages of evidenced-based practice or the ability to interpret advanced imaging or laboratory studies, our hairy doctors learned to identify MI, abdominal aneurysms, bowel obstructions, and appendicitis. Apparently, they learned to use a rather primitive thing that can only be described as an archaic return to history and physical. The chimps had a much more difficult time with back pain, headache, fibromyalgia, dystonia, pseudoseizures, chronic fatigue exacerbations, paresthesias, and imagined insect bites. After several years, we moved the chimps to another secret facility in an urban area, and we secured agreements from local residents to use our hospital for their emergencies free of charge, with the caveat that there would be human oversight. Many of the volunteers said their care was already free in any emergency department they visited, and all we could say was “touch” and offer them gift cards. What follows are a few observations gleaned from six months of patient contact with our staff at what we affectionately called Monkey General. In a surprising turn of events, the chimps went on strike until the name was changed to Chimp ER, expressing with much thrown feces the fact that they do not consider themselves monkeys and are devoted fans of “ER.” Chimp Alpha was the triage technician. He was compassionate and caring, and excelled at separating the sick from the not-so-sick. He had a bad habit of tasting patients, although this proved an accurate means of diagnosing MRSA in draining wounds. Sadly, after two months in triage, Alpha broke down and ran screaming through the facility signing, “10, 10, 10! They're all 10s!” After a brief period of sedation, he returned but spent most of his time looking at National Geographic and making raspberry noises at patients complaining of pain. And flinging feces. Chimp Beta was in charge of stocking the department. A delightful and brilliant primate, the monotony of endlessly stocking tongue depressors, Q-tips, and syringes resulted in her developing a terrible smoking habit. Rather than taking her fruit break, she was often found in the parking lot inappropriately touching patients' male family members and signing for cigarettes. She was taken into custody by animal control when she was found driving a patient's motorcycle after obtaining a somewhat suggestive tattoo on the inside of her lower lip. Chimp Gamma was the nurse. Patients loved her because she comforted them tenderly. When children were crying, she would do acrobatics, and when adults were angry, she would simply climb into their arms and hold them close. Many potential complaints were diffused. She excelled at wound care and learned to give IM injections. After discovering her distaste for staying up all night, however, she moved into an administrative position and left patient care behind. She later presented us with pages of drawings which were suggestions for improving patient care. Prominent among her suggestions were symbols that seemed to suggest cannibalism. Chimp Delta was basically an orderly, and provided the muscle of the team. He was a little older but physically powerful. He once carried a patient, hospital bed and all, into the CT scanner. Unfortunately, even chimps only have so much patience. After a particularly bad Saturday night of intoxicated and drug-addicted patients, Delta witnessed a person being loud and angry with Gamma, for whom he obviously had feelings. The patient, an obese and angry man, was later found stuffed into the MRI tube, which was about half his size. With litigation pending, Delta was traded to a unit using primates to search for overseas terrorists. Chimp Epsilon was our physician. Epsilon exhibited an incisive mind and a tender touch. He was a big hit with old, demented ladies who had grown up watching films and visiting zoos with assorted primates. He was less of a hit with patients suffering from the hallucinations of alcohol withdrawal, especially when annoyed human staff referred to him as the yeti. His diagnostic acumen left us constantly amazed: He detected pregnancy in teenagers, abuse in crying women, and a hidden stab wound in a crack addict. Sadly, he was easily tempted, and impregnated Gamma and Beta, probably within 15 minutes of one another on a slow shift. The two females argued heatedly, and Epsilon tried to hide in closets and clothes hampers. His medical skills were further offset by his tendency to surf the Internet for luxury cars and vacation homes and to look for what most would call zoology, but what was really monkey porn. He eventually was returned to the wild when he ran up credit card bills ordering fine wine. When confronted with this, he signed, “You can't touch me. I'm a doctor, damn it.” Chimp Mu was the unit secretary, in charge of answering phones and ordering labs and x-rays. Everyone feared her, and gave her extra fruit, and cigarettes and methamphetamine commandeered from patients. Once, when Epsilon was looking over her shoulder and poking her for lab results, she attacked him, dragging him around the department by his nose and signing, “No hovering. You not vulture.” In the end, she spent all of her free time on a cell phone making prank calls to PETA. Patient comments ranged widely, but were mostly positive: □ “I loved the monkeys, man. I mean, dude! Monkeys! They rock!” □ “No doctor ever listened to me that intently. It was like she was looking inside my soul.” □ “There were monkeys? Man, I just thought it was the mushrooms!” □ “I ain't paying nobody, so I don't care if it's a monkey or a crocodile long as I get my Lortab.” □ “I didn't understand why the chimp in triage was so confrontational. She clearly had some personal issues. I want to talk to administration.” □ “I thought the tall one was kind of cute.” □ “I thought it was weird at first, being licked by the ape. But he found what was wrong with me after I had been going to human doctors for years. I owe him my life!” □ “I got monkey CPR. What was on the ape's breath?” There were more findings, but suffice it to say, chimps did the job much the same way we do, with skill and dysfunction, love and anger, knowledge and guesswork. The government plans to make the chimps available as soon as avian flu is on its way. Or plague, smallpox, meteorites, tsunamis, global climate change, a new Ice Age, or socialized health care. Whatever happens, we will always know that waiting for us in an ED someday will be short, hairy caregivers in lab coats, hanging upside down and screaming, just like every other day in the good old emergency department.