Add A Splash of (Brown) Color

Sometimes I forget that I work in the Bellevue ER; that I'm in the middle of New York City; that I'm at the crossroads of the world. Sometimes I think that all ER's are the same, and you see the same things and the same patients no matter where you go, from bucolic Iowa to the knife-and-gun club of Cook County.

And then every once in awhile some random event in the ER will grasp my head and wrench me back into reality, followed closely by the conclusion: "yep, I'm in New York, and I'm in Bellevue. And this place is a theater of the absurd."

Such was the case just recently.

One not-so-lonely night in the ER, there was a slow but steady stream of patients with the usual nighttime myriad of complaints: cough, cold, fever, asthma attack, even a broken limb or two. I was sitting behind the central ER desk (eye of the hurricane), gossiping with the nurses and filling out some charts in the small amount of downtime that I had. The only commotion swirling about the ER at that time was the prisoner who was just brought in from Riker's Island who had yet to be seen by a doctor. He was visibly upset about something, and every few minutes he would mutter an obscene phrase or two in the general direction of the staff or police.

"How was your date with that set-up, Sarah?" I asked the nurse as I was furiously charting the last patient I just discharged.

"It was alright," she said. "He scored points by paying for a nice dinner, but the dude was just not quite my type."

"What's your type?" I asked.

"Not ugly."

"Are you going to call him?"

"He already called me. Twice."

"When was your date?"

"Yesterday."

"That's a little suffocating."

"To say the least. I think he thinks that --"

"Sorry to interrupt, Sarah," I said as I abruptly cut her off. "But do you smell that?"

"Smell what?" she asked.

"I think...I think I smell a code brown," I said.

Sara turned her nose up into the air and looked around in no specific direction. Whiff whiff. "I definitely do. Did someone shit in their stretcher?"

This (a "code brown," as we call it) actually is not an uncommon occurrence, especially when one deals with the very ill. Having gone through four years of medical school, gross anatomy, gross pathology, and 1.5 years of residency so far, I've been exposed to the gamut of both intracorporeal and extracorporeal fluids. Like most people, I used to recoil in disgust. After enough repeated experiences, however, one is desensitized, no matter how much one thinks he or she will not be. Each resident, however, is entitled to usually one exception to that rule. My exception happens to be fresh, food-filled, chunky vomit. No matter how many times I see it, and no matter in what quantity, it evokes a visceral response in me that brings up my own vomitus to near-expulsion. But otherwise, I'm pretty much okay with whatever is around. Blood? Not a problem anymore in the least, even if it's pumping out of an artery across the room. Pee? It's normally a sterile liquid, I could care less. Poo? Hardly a second thought, just natural waste material. Mucous? It's just a natural secretion. Even bile -- though it's green and warm, is still -- to me -- a natural excretory substance designed to help us digest our meals.

So when Sarah (or anyone) asks me if someone shit their bed, it just takes a blithe, non-chalant form with an air of insouciance to all the staff. It's like asking if the patient in bed X had their EKG already done: you just chalk it up to daily ER business and simply say yes or no.

Or in this case, I don't know. I did smell poo, that's for sure. And in this business, if you smell poo, then there is poo. I thought Sarah and I were going to have to go looking for the culprit, but that's when I heard it:

SPLAT.

And again:

SPLAT.

I looked up from my chart and swiveled around in the chair. And there, on the wall in front of me, was a flattened turd stuck to the wall, about six feet off the ground. Radiating out in all directions from it were satellite turds that had broken off upon impact. About three feet away on the same wall was a similar exploded asteroid with its own orbiting remnants.

"YOU MOTHERFUCKERS!" screamed the guilty party. Sarah and I turned around more and saw our culprit -- the prisoner from Riker's Island.

"IS HE THROWING SHIT AT US???" asked Sarah in disbelief.

"Yeah and you'd better duck fast!" I replied.

SPLAT. The wall was starting to look like a Jackson Pollock, albeit monochromatic.

"WHO THE FUCK YOU THINK YOU GUYS ARE?!" screamed the prisoner at no one in particular. "YOU THINK YOU CAN JUST ARREST ME FOR NO GODDAMN REASON AND LOCK ME UP? I GOT RIGHTS YOU KNOW! MOTHERFUCKERS!!!"

In a regressive display of behavior, this evolutionary speedbump had actually shit into his orange "NEW YORK D.O.C." jumpsuit (it was just missing that ubiquitous 'I heart' in front of it), and he was reaching around with his free, uncuffed hand (the other being cuffed to his stretcher) into his pants, pulling out semi-solid feces, and hurling it in no particular direction in a display of general rage at his predicament.

"YOU THINK YOU CAN LOCK ME UP? DON'T YOU KNOW WHO I AM, MOTHERFUCKERS??"

The arresting officer who brought him had already scrambled to the other side of the ER, way out of projectile arc-of-the-turd reach.

"Officer!" I pleaded, "can you do something about your guy? He's in your custody!"

"Yeah but he's in your ER," replied New York's Finest. "All I do is watch and make sure he doesn't escape. And he's not runnin' nowhere."

You piece of shit, I thought. Apropos.

Thinking more quickly than the rest of us, like a soldier bolting out of a foxhole, Sarah ran over and curtained off the bed, effectively shielding the rest of us. We could now see the outlines of turds being pelted into the curtain. Surely he would run out of ammunition soon.

We waited.

And waited.

More screams: "I'M GONNA FUCKING KILL ALL OF YOU AND SUE THE PANTS OFF ALL YOU FUCKERS!" (In that order? I wondered.)

And though he continued to scream, the flinging of the poo finally did stop. The ER was already being sprayed down with that orange-scented industrial-strength shit-stomping scentspray. But all that stuff does is mix with shit and make it smell like orange shit.

Even though I had no clue why he was brought to the ER in the first place, I -- nor did anyone else -- go near him until he stopped his turd-hurling. ("Protect yourself FIRST," we were told on day one of internship.) And although he kept yelling in some ambiguous protest of some violation of his self-celebrity, he eventually, well, ran out of ammo.

I had our own 5-and-2 cocktail ready to ambush him. That's five milligrams of haldol, a powerful antipsychotic, and two milligrams of ativan, a powerful sedative. This tried-and-true combination -- also known as Vitamin H and Vitamin A -- could bring down a baby elephant. So with faceshield on, I led a group of gowned-and-gloved hospital police officers into the curtained area. I was actually pretty impressed with our group effort -- in less than ten seconds, despite his howling, he was held down and I injected our cocktail into his shoulder. Just as quickly, we retreated and waited.

Ten minutes later, he was out. Head back, drooling, snoring and sitting in his own dooky. And all anyone in the ER could smell was orange shit.

After hooking him up to a monitor, I again approached his arresting officer.

"What was he sent here for?" Bellevue is the Manhattan County hospital -- anyone in custody in New York City -- specifically, Manhattan -- with a medical problem gets processed, treated and cleared at Bellevue (a source of many other stories).

"He said he had high blood pressure."

High blood pressure? His systolic blood pressure was 145; that's probably lower than mine.

"I don't believe this. All this commotion for a systolic of 145??"

"I'm not a doctor," said the officer, "I just bring 'em here."

"What was he arrested for?" Important to know if it was narcotic-related.

"Petty theft. He stole some beer."

Great. In a massive waste of resources, we were now compelled to give this guy the full monty work-up. He was sedated, so he couldn't answer any questions. The nurses and patient care techs cleaned him up (God bless 'em), blood was taken, labs were drawn. And in my own form of passive/aggressive-but-medically-justifiable revenge, I stuck a large foley catheter in his penis, and put a rubber catheter in his nose to keep him from snoring and obstructing his airway while he was sedated.

He slept peacefully (and sanitarily) for the next six hours. All labs were negative, as were his portable chest x-ray and EKG. All toxicology tests were negative (I lost five bucks to Sarah -- I had my money on PCP, and she bet that he was "just a grade-A jumbo asshole," though they're not mutually exclusive). And except for a blood pressure that never jumped over 150, his vital signs were normal.

He was significantly calmer when he awoke.

"Sir," I said. "Why are you here?"

"I got arrested and told 'em I had high blood pressure."

"Do you take anything for it?"

"No."

"Do you have any other medical problems?"

"No."

"Are you on any medications?"

"No."

"Drugs?"

"No."

"Are you having any problems or pain anywhere at all?"

"No."

I wanted to kick his ass. True, he was 250 pounds and I'm 150 when wet, but still, it's the thought that counts.

I didn't say another word to him. I'm certain he remembered pelting the ER with turds, but in case he didn't, I didn't want to remind him of any future offensive weaponry he could unleash again.

"Officer," I said to his arresting agent, "he's medically cleared. Get him out of here."

A few minutes later, the a.m. shift of residents came to relieve the war-torn and weary, ragged bunch that we were.

Bright-eyed and full of a good night's sleep, one co-resident said, "How was it? Regular night in the ER?"

"A regular New York City night I guess," I replied. And then I gathered my coat and bag and left in a New York minute.