What’s Needling Me, You Ask? I’m Not Really Sure

Posted: November 10, 2014 in Uncategorized
Tags: , , , , , ,

This is Part 3 in the “Stories from the ER” Series I have begun to write. While the details are entirely fictional, the event which occurs in the story is based on a story once told to me by an actual ER nurse. All names have been changed to protect the idiots who come into the ER with unusual sets of circumstances.

emergency

 

Because of the high costs of insurance, many people who can’t afford health insurance – the mentally ill, the addicted, the homeless or any said combination of those — tend to use their local ER departments as a doctor’s office. We get a lot of repeat customers suffering from lung ailments – homeless people catch colds and pneumonia much easier during the fall and winter months than the warmer months– who come to see us for a) a warm place to sleep for a couple of days, b) a free dose of antibiotics and c) scraps of compassion they don’t ordinarily get from those who walk by them in utter disgust as they sleep in alleys and over warm city grates, huddled into tight little balls so they don’t freeze to death during the night.

Since this area of DC has such a high percentage of homeless, and the winters can get really harsh, every year we ask for and accept donations of old coats, blankets, hats and mittens for the homeless to take with them when we inevitably have to kick them out of probably the only warm place they’ve slept in weeks. I must admit, the first few times I had to cut dead and dying blackened skin from the fingers and toes of some severe frostbite victims really had me rethinking a move to the Caribbean.

Unfortunately, I’d really grown attached to both the adrenaline rush and Buster, my five-year old labradoodle who patiently waits for me at home when I have to work double shifts due to high volume patient loads. He is also part of the reason why I keep coming back every time – he is my saving grace and the only one I reserve my tears for when I go home and allow myself to feel the pains and anguishes I bury all day long. He never judges or chides, he just sits patiently by my side, staring at me with big, brown eyes as I let the tears flow for the especially hard cases I never had the chance to win. It seems like lately, I’ve been losing more than I have been winning.

Anyway, I have another story for you. This one isn’t a story of loss, but more of a story about mental illness, and what weird shit mental illness can cause people to do to themselves over and over again. This is Shannon’s story.

Shannon wasn’t homeless. Well, okay, she had been homeless for several  years before she met and married her second husband. She  was taken to the homeless shelter one night by a good Samaritan who had discovered her huddled in the recessed doorway of his apartment complex, shivering and mumbling incoherently to herself. He had noticed she was clean, so he surmised she hadn’t been out on the streets for long. In between mumblings, he was able to piece two and two together and found out she had, in fact, a home – but had no idea where it was or, even where she was at the moment. When the good Samaritan summoned for an ambulance, he made sure to tell them she had spoken to him some and was most likely “not homeless just very confused at the moment”. My ambulance drivers searched through her large, expensive-looking leather purse but, unfortunately, she had no identification. When they brought her in, they weren’t able to tell me much more about her, other than her name. I guess it was up to us to figure out who she was, until she was able to speak for herself.

Bud and Gerry, my drivers, wheeled her in through one of the back door bays, and quickly called me over to her gurney. Assuming the worst, I peeled the gurney out of their hands, mumbled a quick “thanks guys, I’ll take it from here” and started rolling her down the long hallway to find an available room for her. I thought at first she might be another cardiac patient because she was a little blue in the face and lips. However, after further assessment, and hooking her up to the monitors, I could see the EKG was pretty solid, except for an occasional hiccup. The readout indicated Shannon was stressed, but certainly not arrythmic. I was relieved, because I was able to stall for time and leave her be for a few moments to attend to the screaming child with the broken leg who had just been carried into the waiting room, screeching and flailing about as his diminutive mom was trying her hardest not to drop him onto the hard, tiled floor as he tried to squirm out of her arms. It really never is a dull moment at work.

Once the chaos and confusion ended, I headed back to find Shannon fully awake, a little glassy-eyed as she tried to figure out how she got to where she was currently. Her hair was completely disheveled, but as she ran her hands through her hair, I saw something that told me Shannon was neither homeless nor even poor. In fact, my guess was that she lived in a very affluent suburb of DC, and ended up in my ER merely by a series of unfortunate circumstances. Shannon’s fingernails were freshly, manicured. And on the ring finger of her left hand, she was wearing the largest sparkler I’d ever seen – and most likely will never be able to afford. I put its value somewhere in the same price range as my first house.

She caught me looking at her ring finger, and immediately rolled the hand into a clenched fist. She must have assumed I was going to steal it from her. I approached her and said, “Hi! I see you’re awake now. Do you know where you are?” Shannon looked around the room, a baffled expression on her face, then looked back at me and squinted to read the words on my name badge. She grunted a little, crinkled her very perky buttoned nose in what I could only describe as “disgust” and, to my utter surprise, spat out, “What the fuck am I doing in this shit hole? Who are you? Why am I here? What the fuck is going on? WHERE IS MY HUSBAND! He would be appalled to find me here. Get me out of here. Get me out now!”

Something had set her off, and I think it was her less-than-first-class medical accommodations. And me – some lowly, barely blue-collar male ER nurse, whose only fault at the moment is showing compassion for someone whom I can only describe as “a high-maintenance, frigid bitch with cunt-like tendencies.” Yeah, I can’t write that on her medical chart, but I sure can think of her that way in my head.

Shannon sat up, took one look at her hospital gown, and went off on me again! “Doctor! Where tšhe fuck are my clothes?! Gimme my clothes back, you asshole! I paid five thousand dollars for that top — you had BETTER NOT had to cut it off me or I am suing  you, your hospital and everyone else I find out who is involved in holding me against my will! How DARE you put me in this piece of crap cotton – COTTON! I haven’t worn cotton anything since I was six! — get me my clothes!”

All of her screaming and scene making had caused quite a reaction from the rest of the staff. Suddenly, I found myself sharing a bedside emotional beat down with the ER doctor on duty and three other nurses – who were checking to make sure the bitch hadn’t decide to stab me with a pair of suturing scissors when I turned around to grab a pair of sterile exam gloves. Fortunately, we’re trained in nursing school to calmly continue and speak with a calm, soothing tone, for situations such as this. I maintained as blank a stare as possible, indicating I wasn’t going to cower or kowtow to her demands. I just paused and waited until she was calm enough, once again, to let her know why I was worried.

I proceeded slowly. “Hi, my name is Jeff and, no, I am not the doctor here, just the head nurse.” She opened her mouth to protest, once again, but I held up a hand and cut her off before she could lay into me. “As I said, I’m an ER nurse. You’re here in George Washington, because of a good Samaritan’s efforts. You had passed out, of sorts, in front of his apartment complex. He called for an ambulance and my drivers brought  you here. I’m just here to make sure whatever brought you here can be identified and treated, so it doesn’t happen again –” She bit her lip a bit, and was just about to lay into me when, again, I cut her off, “Ma’am, your safety and health is my number one priority at the moment. And honestly,” I paused for a moment, searching for the perfectly rude yet still professional thing to say that would cause her to drop the arrogant, self-entitled bitch attitude she was giving me. Unfortunately, I think I missed the mark. “Honestly, to be walking around in this area of the city wearing a rock the size of the one on your finger is dangerous. People kill people for that amount of extravagance.” Yeah, I can be a bit of an asshole myself when pushed too far.

That seemed to shut her up. At least she wasn’t demanding any special treatment any longer. I continued in my interview, “Do  you have any idea what you were doing before you passed out? Anything coming back to you?” I put my hands to her neck and checked her heart rate through her carotid. They seemed normal. I put the tip of the thermometer in her ear, and waited for the beep – normal temp, good. I used the penlight on her eyes – normal dilation, then I looked up her nose — everything checked out at first glance. Other than looking somewhat disheveled, I had no theories on why Shannon had ended up in my ER. The fugue state she had been found in, was a bit of a mystery as well. Only bits and pieces of it were coming back to her as well.

“I was out with my husband. We had just celebrated his second – and final step promotion – as CEO. He’s the CEO of World Bank — he worked himself into that position practically from the ground up, I’ll have you know…” She was going off on another self-congratulatory, high falootin, brag a thon, when I interrupted her again. I just didn’t have the time or patience to listen to such snobbery. “Can I see your arm for a sec? I’d like to get your blood pressure…”

She rolled her wrist over and offered it to me. That was when I noticed the large, blotchy patch of red that went from just under the bottom of the palm of her hand to midway down her forearm. Her skin was raw in spots — she obviously had been scratching at it for some time – possibly days. Regardless, it didn’t appear to be psoriasis, or ringworm, or any of the other thousands of potential viruses and skin ailments I’ve seen over my years. I was, however, alarmed at how red it was. It almost looked angry.

“What’s going on here?” I asked her – pointing to her rash. Shannon looked down at her wrist, grimaced and – almost disconnectedly, said, “That? Oh, that’s for when I’ve been a bad girl. That’s my punishment.” Her voice had changed. Gone was the angry, pushy, wealthy socialite with the loud, aggressive voice, hell-bent on ruining my career. Right before my eyes I saw her change. She pulled her arm out of my grasp and, furiously rubbing and scratching at her bright red rash, she squeaked out in a tiny, almost childlike voice, “My needles. Mine. Bad Daisy! Bad, bad, bad!” I couldn’t believe what I was seeing take place before my eyes. Shannon, this big, brash, larger than life woman, was regressing into a child. I watched as she started curling into a little ball on the bed — trying to shrink as far into the bed sheets as possible.

I suddenly had the impression that I needed to call in a psych consult for her. Perhaps a psychiatric evaluation can be of help here. I’d never seen anything like this before – and felt it was out of my depth. I could, however, help relieve her of the pain and itching coming from her wrist. I leaned in for a closer inspection. I place my two fingers on her wrist and felt a series of small ridges. I moved my fingers over the ridges and felt something under the skin move as well. Shannon had something stuck under her skin. I rushed her down to the X-ray lab and had the technician run some prints for me. Fifteen minutes later, I got my answer: sewing needles. Shannon had over forty of them, at end of count, shoved under her skin. How long they had been there was anyone’s guess. That was,  until the psych evaluation came back.

Shannon, as it turned out, had dissociative identity disorder. More commonly known as multiple personality disorder. Through picking apart and putting together bits and pieces of her story, we were able to locate her regular psychiatrist who confirmed her case.

What I had seen that night, other than the rash of course, were two of the seventeen personalities this patient has living inside her. That explains how she ended up in the doorway of an apartment complex in a bad area of town. It turns out one of those seventeen personalities decided to turn a few tricks that evening.

Who knows how things would have turned out  for her if it hadn’t been for that good Samaritan. I, too, might have cheated another date with death as well.

needles

 

 

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