Beth Stillman: 3 AM in the ER

Late one night in the ER, doctor Bess Stillman treats a patient with an interesting dilemma.

Bess Stillman is an emergency physician and writer living in NYC. She has appeared on The Moth Radio Hour. Find her at http://www.bessstillman.com.

This story originally aired on May 19, 2017.

Story Transcript

It’s 3 a.m. during a Saturday overnight shift in the ER when a patient comes in with a chief complaint of rectal pain.  And because I’m the overnight physician, I know this is going to be a pain in my butt too because nobody comes to the ER at this hour with that complaint if it’s something nice and normal, like hemorrhoids. 

The good news is that I have a medical student working with me that night.  He has come all the way from a medical school in Kansas because, as he tells me, there is nowhere like New York City to do your emergency medicine clerkship.  I mean, just the cross-section of humanity--there's the citizens and the immigrants and the haves and the have-nots, there's the gunshots and there's the stab wounds and there's the heart attacks and the strokes and the sane, the not sane, and the criminally insane.  You guys have everything.  And what the stress must be doing to the inside of eight million bodies.  They're all going to come to the door and I’m going to learn from them.  So yeah, he's a little intense. 

And when he looks at me, I can’t tell if he wants to wear my skin or absorb my knowledge.  But he is enthusiastic, which means that all of the things that I hated doing as a student and that I still hate doing, I get to pawn off on him as long as I frame it as a learning experience. 

Don’t judge me.  Judge the system. 

So I send him in to see this guy.  He comes back out and my student presents to me, “The patient is a forty-five-year-old man who presents with a chief complaint of rectal pain.  It started three hours ago while sitting in his favorite chair doing a crossword puzzle in purple ink, his favorite color.  It’s a seven out of ten on a pain scale.  It’s sharp, non-radiating, and not associated with vomiting or diarrhea. 

So then I go in to see the patient and I get the exact same story.  I mean, down to the detail of the purple ink.  And so now I know something’s up, because nobody tells the same story twice unless they've practiced it. 

So I go back to my student and I say, “Okay.  Why don’t you tell me what you think is wrong with this guy?” 

So, very excitedly, he says, “Well, it could be cholecystitis, cholelithiasis, sigmoid volvulus, cecal volvulus.  Oh, appendicitis, a kidney stone.” 

“Okay,” I say. “Maybe.  I think he has something up his butt.” 

My student turns red.  “No.  No way.  I checked.”  Which is actually the one thing you are never supposed to do.  I mean, just like you wouldn’t stick your finger in a hole on the ground just in case a small animal comes up and bites it off, you never put your hands anywhere inside a patient where you think something is hiding. 

I've found needles, I've found sharp objects, things that people have stuck up there to hide from the police or to purposefully hurt you with. 

So now my student is just staring at his hands, like searching for imaginary damage.  He looks traumatized.  And I say, “It’s okay, it’s okay.  Just don’t do it again.  And why don’t we get this guy in x-ray.” 

So, by now, word has gotten out that there's a Code Brown in the ER, which is exactly what it sounds like.  So the radiology suite is just packed with doctors and nurses and techs all just staring at this large monitor where the images are going to show up. 

And we look like a bunch of curious owls.  We’re just kind of… I mean, there's something up there, but we can’t really tell what it is.  I flip the image a hundred and eighty degrees and there.  I see it. 

It’s a little man. 

At least I think it’s a little man.  There's this really large bulbous head, these two skinny arms, two skinny legs.  If this is Ken, he's strayed so far from Barbie. 

So I ask my student, “Why don’t you point out what you see?” because I really want to be a good teacher in this moment.  I mean, he has come so far to learn from me, but I know that I’m not really teaching him anything about how to read an x-ray.  I am teaching him how to lose faith in humanity, which, to be fair, is exactly the kind of lesson you would come to New York City to learn. 

So, to try to make it up to him, I ask if he would like to do the honors and remove the object himself. 

He replies, you know, he has just decided to become a radiologist so that he never has to touch a patient again.  This seems fair. 

So I go back to the patient’s room.  “Sir, anything you forgot to tell us?” 

“No,” he says.  

“I mean anything.  Anything at all.” 

“No.”  God, I love how committed he is to this story. 

So I go along with it and I say, “Well, this may come as a shock to you, but there appears to be a tiny man in your bottom.” 

[Gasps] He says--I’m actually talking, like, the pearl clasp--“Do you know how this must have happened?”  Oh, tell me.  Please, tell me.

“Well, my brother and his kid are staying with me.  They're visiting from out of town.  And you know how kids are, he leaves his toys just everywhere, just like Hot Wheels and things that you can slide on.  Well, you know, last night I took a late night shower after they went to bed.  So I walked back to my room wearing just a little towel and I slipped on something and, bam, I hit the ground so hard.  That must have been when.” 

“Yeah,” I say, “that must have been when…  How about we get that out of there for you?”

“Where do I sign?” he says.  And he actually reaches behind him and he pulls his purple pen right out of his backpack. 

I will spare you the gory details, but I will tell you that it was a breach birth.  The gentleman came out feet first.  And when he did, we saw that it wasn’t just a man.  It was a spaceman.  It was Buzz Lightyear. 

The nurse I’m working with comes up behind me holding a biohazard baggie and she opens it and whispers in my ear, [in song] “You've got a friend in me.” 

I drop Buzz into the bag and I shut it and I just start taking off across the ER and my student trails me and goes, “Where are we going?” and I so badly want to say, “To infinity and beyond!”

But I don’t.  Because really we’re just going to the locker room, where we actually keep a bucket in a locker that is filled with things we have pulled out of people that week.  Right now, there are two Hot Wheels, a headless Barbie, and a crack pipe. 

So I drop Buzz into the bucket and I look at the clock and I see that it’s only 3 a.m.  I mean, the night is still young.  East Village is just getting started.  So I wonder aloud, “What else do you think we’re going to pull out of someone tonight?” 

And my student looks at me with the full realization that he is not in Kansas anymore.  He looks at me with this mixture of disgust and despair and says, “What do you mean, tonight?” 

Thank you.