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 My PEN PAUSED oN THE WoRD Pain. “THIS IS A SEvENTyfive -year-old man with a chief complaint of chest pain.” The pen drifted downward across the chart, as if it were a mountain climber sliding down a glacier, and finally dropped off into my lap causing me to startle, open my eyes, and realize I had fallen asleep. I looked up at the clock: 7:55 a.m. My relief would be here in a few minutes. I could coast and do nothing for the next five minutes and congratulate myself that I had made it through another night shift. My body ached, and my feet throbbed from the constant standing and walking. My back hurt from bending over and suturing a man’s bleeding eyebrow. Someone had hit him with a bottle at the Blue Spruce, one of Albuquerque’s most violent bars. My eyes were blurry, barely able to focus on the chart and the triage note. My stomach had cramps, which usually signaled diarrhea at the end of a shift. “Hey, you look wiped out,” said Rick, my replacement. Rick had been working in emergency medicine for close to twenty years. We had been residents together even before we worked in the emergency department. He made a point of stating the obvious, as if he were jotting down a data point in a research study. If we walked by a pale, lifeless body that had bled to death, he would say, “That guy looks bad.” or he would say, “odor of alcohol on his breath,” about a patient who was unconscious and reeking of alcohol. So when he said I looked wiped out, I realized I must look really exhausted. “yeah, it was one of those nights,” I said. chapter one  • david p. sklar “Well, better you than me.” He laughed. “yeah, there was a gang fight. Two kids died from stabbings. There was blood everywhere; it was a mess,” I said. “guns are cleaner,” he said. Rick had straight brown hair combed back, thick glasses with wire rims, and a gray-brown beard, which often caught bits of food and ice cream. He always wore a tie and white shirt under his white coat and kept his black shoes shined. “We should hand out guns to all the gang kids and let them get it over with all at one time. Problem is, they are so stupid they’d probably miss.” “Rick, isn’t that a little racist?” I said. “It’s not. I’m not saying that they are Mexicans or Indians or blacks or whites. It doesn’t matter. But they’re all stupid. They can’t read. They knock up their thirteen-year-old girlfriends just to show off. And they knife each other because one guy stares at another through a car window and twists his finger wrong.” “I’m too tired to get into it with you now, but you know it’s not that they are stupid or lazy. It’s about not having a dad in the house, no jobs, and drugs on every corner. How can you come in here every day and take care of them if you hate them so much?” I asked. “It’s like veterinary medicine. you just have to watch out for the teeth and claws. It’s like a zoo. Don’t you like watching the chimpanzees and the polar bears and the tigers? I like going to the zoo,” he said, laughing. We walked around the emergency department and went from bed to bed. “Bed 1 is a forty-two-year-old woman with possible appendicitis who is waiting to go to the oR. Check and make sure the surgeons don’t forget about her. Bed 2 is a thirty-year-old woman with pancreatitis . Her amylase is 4,000, and her calcium is 7.9. She’s admitted to medicine.” “How long has she been waiting?” he asked. “Just a few hours,” I said, and he nodded. “I’m sick of all these patients waiting for beds,” he said. “I don’t want to know about anyone who has already been admitted.” “But, Rick, what if something happens, and a nurse comes to you with a request? Don’t you want to have a note written down so you can do something?” “No,” he said. “It’s not my problem. I’d rather not know about it. It’s like those starving children in Africa. When you see pictures...

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