[Ann Emerg Med. 2009;54:475.]
My shift started the way a disturbing number of them start: I was looking for doughnuts. I figured my chances were pretty good, since it was a day shift and a Sunday. The need for coffee on the way to work, combined with the goodwill of Sunday, increased the likelihood of someone bringing in a box of doughnuts. And so I searched.
I found them on top of a cabinet and did the quick inventory, looking for a honey glazed. All I eat are honey glazed, which pretty much means I need to be the first person to the box if I'm going to get a doughnut, since honey glazed don't last. This was a lucky day, though, because wedged between a chocolate frosted with sprinkles and Boston crème was my doughnut.
I wasn't hungry yet, since it was only 7 am, but I didn't have anywhere to put the doughnut to keep it safe. I mulled this over. This is the story of my life. I come from a big family, the kind of big that is frankly irresponsible in this day and age. Growing up in my family, you needed to be quick to get something to eat, or it would be gone in a blink. You needed to be quick, or you needed to be smart. I wasn't the fastest, and I wasn't the biggest, but usually, if I really wanted something, I could “reserve” it. I needed to make a deposit, of course. Mark it for myself. So I'd lick it. More than that, I'd lick it in front of my brothers, so they'd know it was mine. Usually, they wouldn't want to touch anything I'd licked, unless it was something really good or they were unusually hungry.
Unfortunately, too many people work in the ED to watch me lick a doughnut. I couldn't just gather them around for that kind of show. So instead, I took a single bite and put it back in the safety of its orange box. This seemed the safest course of action, and likely as effective as licking. And so I got to work.
After seeing a few patients, a resident presented a 4-year-old boy who had had a tonsillectomy 2 days before. The poor kid was miserable. His mom said he couldn't take anything by mouth, couldn't sleep, wouldn't drink. She had called the surgeon and had been doing everything right at home, but he was just not getting any better. We did our thing: intravenous fluids, pain medicine, lidocaine. But he wasn't going to drink. He wouldn't even have opened his mouth for a doughnut, honestly. So I called ENT.
ENT called back, and we discussed this boy. We also discussed that they don't like to be called “ENT” or “Super-dentists,” either, for that matter, even when capitalized. But that's a story for another time. We discussed the boy at length: his pain, his dehydration, the fact that he was so recently post-op. We both agreed he needed to be admitted to the hospital. But ENT felt he should be admitted to pediatrics. “Dehydration is not a surgical problem.”
I tried my best. I played the postoperative complication card, pointed out he wouldn't need to be admitted at all if he hadn't had surgery, that his surgery was performed by ENT; therefore, by transitive property of mathematics he should be admitted to them. ENT would not budge. I became angry, probably unreasonably so, arguing that they were abandoning him. He was their patient, after all. Possession is nine-tenths of the law. He belonged to them and their service. They had taken a knife to him, which is akin to licking a doughnut. You can't change your mind after that kind of investment. Their mark was on the child, and they should not, in good conscience, make someone else admit him.
But ENT reported that they had not really gotten along very well with the child's mother. Yes, they had operated on him, but no, they didn't enjoy the therapeutic relationship, and no, they were not interested in continuing it. Thank you for the consult.
Sheepishly, I admitted the little boy to the pediatric hospitalist. She's always hungry for business, even when the patient isn't really hers.
In celebration of a job well done, I got myself some ginger ale. My doughnut with its missing bite is probably still in the box. I just didn't want it anymore.
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