[Names have been changed to protect the innocent (and the guilty)]
Jack was an asshole. A mean, malingering, histrionic jerk who seemed to be placed on this earth purely to torture healthcare workers. To know him was to loathe him, and boy did we know him well.
With over 200 ER visits under his belt, every doctor, nurse, tech and paramedic had a Jack story. He had just enough legitimate medical problems that you could never ignore his chief complaints. He would show up with actual disease just often enough to always keep you on your toes.
His tormenting of the EMS system was the stuff of legend. He used to find a payphone right at the state line and call 911, knowing full well that it would take the ambulance crew longer to get to the hospital (and thus give him more time to receive IV fentanyl for his 10/10 pain). One day he pulled that trick, came to the hospital, got worked up and discharged, took a free Medicaid ride back home and went to the same pay phone and called 911 again. The man had big brass balls.
Nurses would fight over who got stuck taking care of Jack. His veins were shot. He was verbally abusive. He had an insatiable appetite for Dilaudid and turkey sandwiches. Nurses who heard the familiar medic radio report would hold on to their current patients until Jack had safely arrived and been sent to a different assignment. I can’t blame them. As a doc I can walk in and out of the room as I please. Jack worked that call bell like if he hit it enough times he might win a prize.
ER docs didn’t mind taking care of Jack, but they weren’t particularly looking forward to it. The tough part wasn’t caring for him in the ED. The tough part was trying to get consultants to come see him. You see, the legend of Jack went far beyond the ground floor of the hospital. Hospitalists, cardiologists and surgeons all associated the name with B.S. More seasoned ER docs would never reveal Jack’s name when calling a consultant. “Chest pain rule out, room 8”. Some gifts are best experienced in person, rather than over the phone.
Docs and nurses talk about our frequent fliers like they’re old battle scars. There’s a perverse pride that comes from dealing with the steady stream of nonsense. Sometimes we shake our heads. Sometimes we laugh to the point of tears. At no time does anyone say they regret working this job.
It was a cold January night when the medics brought Jack to me looking like death warmed over. He was febrile, tachycardic and as jaundiced as could be. “I think I finally did it this time, doc. I think I fried my liver”. At that moment I saw something in Jack that I had never seen before: fear. In all the times I had attended his performances, I had never seen legitimate fear in his eyes.
Jack had every right to be afraid. With a lactate of 17 and a pressure tanking his instincts proved to be right. After ordering IV fluids and broad spectrum antibiotics I got on the phone with surgery, GI and the ICU. Every conversation went the same way: “You’re not going to believe it but Jack is septic and he’s crashing.” To their credit, each consultant put their biases aside and rushed to the bedside. They treated Jack as good as they would have treated the CEO of the hospital. I was proud of my colleagues for rising to the occasion.
Ultimately, their efforts were in vain. On ER visit #219 Jack was admitted for septic shock and died the next day. It felt like the hospital should lower its flags to half mast. At the very least they should have lit a candle next to a turkey sandwich and vial of Dilaudid. Word spreads quick in the hospital. Within 24 hours everyone had heard the news. A legend had died.
A funny thing happens when you’re dead. All the bad things you’ve done seem to be a little more palatable. Your redeeming qualities seem to shine a little brighter. For the past week the doctors and nurses have been retelling Jack stories to each other. There’s a little something extra in our voices when we tell the stories now. A mixture of pride and wistfulness gives the stories some extra flavor.
Jack’s obituary was in the paper today. At no point in any of his 219 visits did anyone see a single friend or family member with him. For all I know, they never knew he ever set foot in a hospital. The obituary listed all the friends and family that loved him and missed him. They described him as kind and generous – the kind of guy that would give you the shirt off his back. Attached was a photo of him smiling ear to ear wearing a tuxedo. I don’t know if that was the only picture his family had of him, or if that’s truly how they saw him.
Everyone in healthcare has their trolls. Some can be mean. Others can be soul-sucking. Some trolls wake up in the morning, look in the mirror and ask themselves “who can I torment today?”. Although they may seem indestructible, all trolls eventually die like the rest of us. I’m glad I drew the short straw on visit 219. Seeing Jack in that state reminded me of his humanity as well as my own.
Somewhere out there a bridge is missing its troll, and today – so am I.
Rest in peace, Jack.
What do you think? Who are the trolls in your life? When an infamous legend dies, does it change the way you feel about them? Do you exchange war stories with your colleagues and wear them like badges of honor? Share your thoughts and comments below.