What’s the Craziest Thing You’ve Ever Seen?

I looked up from my e-mails around ten of one. Nearly all of the new hires had returned from their lunch break and were taking their seats at the rows of computers that filled the room. Some chatted quietly while others slowly made their way through stacks of index cards. I did a quick head count and began loading up the next set of slides. “Just a few more minutes, I think we are missing a few people and then we’ll get started again. Any questions so far?” I asked as I carefully adjusted the projector.

From the back of the room a hand emerged over the monitors and someone asked, “Well, you’ve been doing this for a while…What’s the craziest thing you’ve ever seen?” It is a question I have come to expect, but one for which I have never perfected an answer. I poured over my months spent working in the ER. There were a number of cases that raced to the forefront my mind. I thought back to a scorned lover presenting with SI and an ode carved carefully with a razor blade into his lower leg. A mother weeping over her toddler as he was intubated, knowing full well that she was responsible for the illegal drugs he had stumbled upon had ingested. An elderly woman cursing angrily at everyone on the floor at the top of her lungs for 4 straight hours. An intoxicated high school student who had managed to hide 5 bottles of vanilla extract in her hospital bed and steal the car keys of her provider.

Although these stories are memorable in their own right, I have found it is not always the most outlandish or medically fascinating cases that have stuck with me. I thought back to an older woman who had suffered a stroke and was brought in for trying to pull out her trach tube. She was alone in this world and had never had the ability to let her wishes be known. She was no longer considered to be of sound mind to make any choices. Her legal guardian was an attorney and she was considered a full code. Medically her case was simple, reinsert the trach and restrain her arms until she could be sedated. I watched as the woman languished in the ER all night staring off into space with a mournful gaze occasionally tugging helplessly at the soft restraints that held her arms to the bed rails. Of all the trauma, puss, blood and gore I had seen the ER, no other case made me more sick to my stomach.

I looked around the room noticing a few eyes slightly widened with excitement looking back at me. Today these scribes were eager to learn and help, and slightly naive to cases that their providers would face that go beyond the science of medicine. I shrugged and decided that they had time to consider and wrestle with such moral dilemmas another day. “Well, this one time…”