Stories from the Emergency Department

by Mary Beth Engrav

Stories accumulated by an Emergency Physician about patients seen in a busy Emergency Department. These are case reports of real situations seen in the practice of a 20-year-veteran physician of the Emergency Department. The following is an Another child who stands out, for different reasons, was a three year old with a scalp laceration who I will call Max. Max was there with his mother who seemed even more unhappy than the average parent to be at the ER. Max had, of course, hit his head on the coffee table, the bane of a three-year-old’s existence. I truly believe that if everyone got rid of their coffee tables it would reduce the ER census by 10%. He had a very small, approximately 1 centimeter laceration, but it needed stitches. At this age, I would estimate that 90% of the time I can reason with the child, have a long discussion about imaginary things and fairy tales that I make up, and we get them through it. If the child is below 18 months in age, it is just a “get it over with procedure”, there is no way they can understand it, but by two to three I pride myself on making it a good experience for them. Right away, I realized that may not be the case with young Max. He was screaming with any attempt to look at the laceration, even though I didn’t even touch him. By the time he had seen three of us in scrubs (the triage nurse, the nurse, and me), he would scream even if he saw someone in the hallway in scrubs. We decided it would be in his best interest to restrain him in a sheet which we gently wrap around the child; it is less traumatizing than the old boards with Velcro straps we used to use. His mother agreed. We gave him a small dose of sedative medicine as he was so remarkably agitated, part of which he spit back at the nurse. He ripped off his topical medication and screamed bloody murder even when the nurse had tried to apply it. After he was held down gently, I began to numb the wound with injectable lidocaine. If a child is screaming even when we aren’t doing anything yet, even though they’ve received the topical numbing which works very well, I can’t gauge their pain response during the procedure. So I just have to go ahead and put injectable numbing medicine into the laceration to be sure I’m not hurting them while stitching. “JESUS FUCKING CHRIST!” I thought he said as I carefully injected his laceration. I shook my head slightly, and thought to myself, I’m sure I misunderstood what he just said. Sometimes when kids are crying you can almost hear words in the cry. I started washing the wound. “FUCK! FUCK!’ he yelled. Everyone in the department was now quite silent, as they could hear this. As we continued, we were treated to every bad word in the English language. From a three year old? Could this be right? I glanced quickly at the mother as I worked, she had her hands on his legs, helping hold Max, and her head was down. She was doing deep breathing exercises, the kind you do during labor. As we wrapped up, I pretended I hadn’t heard anything and started giving her wound-care instructions as the technician cleaned the wound and lifted Max up out of the sheet. “I want to tell you, I really apologize for the language. He has four older brothers, the oldest is 17, and he has really learned all of the words and when to use it.” This made it quite understandable to all of us, and we all got a laugh out of it. When I think about it, he was just saying what every toddler who is sutured would like to tell us but can’t. Needless to say, I did not receive a thank you card from Max or his mother, but I still think about him often.

Genres: Medical, Nonfiction

190 pages, Paperback

First published March 31, 2011

Reviews

[Margaret Kolstad]

interesting read

Interesting read about life in the ER. Very easy to read and lots of interesting stories. Well written by author.

[Lawon Weeks]

Very good

Has to be the best book on this subject that I've read. Well written in understandable words for a layman and very descriptive cases. Dr. Engrav gives everyone credit for their assistance and includes the information that patients and their families should be sure to share with the medical staff.

[Melanie Rowley]

Great book

Enjoyed this very much. Very well written but they need a proofreader as there were errors. I hope more ER books are written by this doctor and soon. I did not want the book to reach the end. Such a treat to find a book that you are eager to open for days.

[Donna McDermott]

very American

Really interesting but difficult at times because US and UK medicine can be very different. Some additional proof reading would have benefitted too. Overall, worth reading.

[Margaret Agard]

Kept me interested

For some reason I've become addicted to medical personnel memoirs, lately. This is one of the better ones. It's organized slightly differently than most - along medical themes such as fractures, or medical mysteries. Well done

[jill silverman]

excellent she captures what the ER is exactly and i say this after having been an ER RN f0r over 35
years all over this country! She and Nick Casto[ER DAYS] are the only ones worth reading re the subject,

[joyce lee middleton]

Excellent!! Thoroughly enjoyed ❤️

So well written, interesting both good bad and really bad. Received a lot of very good information from this read. Thank you so much for writing this, much appreciated ❤️🫂

[Debra]

Full of typos and missing words

This book needed an editor. There are multiple missing words and letters, and duplicated words. It would have been more entertaining if it were edited.

[jan]

Thank you!

I have had many ER visits over the years, and this book taught me a lot of things that I had questions about.

[Robert Dodd]

nice pace

Nice pace, clear, human centered stories . She didn’t go for wow stories but stories highlighting the process and qualities of patients and care givers.

[Cynthia Mccormack]

informative book, but…

I enjoyed the read, but the editing is poor. Many punctuation, grammar, etc. mistakes. For me, this always reduces the credibility of the author.

[Eleanor Shumaker]

excellent!

Utterly fascinating stories, clearly, and well told. And the kind of doctor you wish could be your doctor!
I hope she will write more!

[Allyson Dyar]

Book Reviews: Two of a Kind

I decided to take advantage of my hour long lunch hour by taking part of it and reading books. Right now, I’m concentrating on non-fiction, Medical History books; eventually, I’ll get back into reading fiction.

One of the last of the hardcover books left on my shelf is The Making of Modern Medicine: Turning Points in the Treatment of Disease by Michael Bliss and the next book was the Kindle version of Stores from the Emergency Room by Mary Beth Engrav, MD.

I’m combining both reviews into one because after completing my reading, I was left with the same feeling of bewilderment: these books were very well written, interesting to read but ultimately left me unsatisfied and unlikely to read them a second time.

The Making of Modern Medicine by Michael Bliss can be described as not only a very short book but a preface to three of Dr Bliss’ three other books: Plague: A Story of Smallpox in Montreal, Williams Osler: A Life in Medicine, and The Discovery of Insulin (which I’ve read and previously reviewed). It’s not that the individual stories weren’t interesting but they were obviously written to prompt readers to read the actual books and honestly, as a reader, I feel duped. I’m sad to say that, but that’s honesty how I feel. Yes, the information was interesting and well-presented, but it was obvious presented more as an over-view, rather than in-depth analysis.

I didn’t really have that problem with the second book, Stores from the Emergency Room. It was an interesting collection of anecdotes of interesting cases Dr Engrav had encountered while an emergency room physician. The stories reminded me of the Emergency Room itself: tell the story, get the patient off to a specialist.

Perhaps I’m picky, but I seriously wanted more background: hospital background, background of Emergency Medicine in that hospital, background of Dr Engrav herself. Something. Anything more than, “here’s the patient – here’s what we did -- there goes the patient.” Yawn.

I had a hard time coming up with a rating for these two books and I’ve decided on ***/***** but in reality, I would give them each 3.5/5 stars. Well-written but ultimately unsatisfying.

[Andrew Niemann]

I was initially put off because the book seemed to start out a bit too clinical, but as I got into it, it began to have the right mix of clinical with emotional and the "story - telling" flow began to take over. When it comes down to it, this book was series of anecdotes that I was sad to see end. Also found several statements that I may have to quote in the future.

[Nancy]

Light read, very quick. Involves the reader. A few typos here and there but no big deal.

[Kate]

Good stories but poor editing

I enjoyed this book quite a bit but the editing bothered me at times. Worth a read though! It had some excellent stories and it was very insightful.