Just Shut-Up Already, Whitebread!

Usually while I’m doing procedures on patients, I try to distract them and pass the time by making small talk. Sometimes I end up saying things that seem right at the time but in hindsight are probably just silly. Here are two examples:


1.
When you work Saturday night overnight, you expect a few drunks or a few bar brawl injuries to show up around 2 am as the bars close. This past Saturday night was no exception. Around 3am I looked over at room 3 and saw a young girl holding a blood-soaked rag to her mouth. The chart in the rack listed "smashed in face with bottle" as the chief complaint.

"Doc," she explained as she lowered the rag from her mouth, revealing a huge bloody gap where her two front teeth should have been as well as a badly cut-up mouth, "Someone smashed me in my face at the club. I look horrible, don’t I? Look, doc… I’m a prissy pretty girl, so you gotta sew on me like you’re Dr. 90210, okay?"

None of her lacerations were anything requiring a plastic surgery consult, which meant putting her face back together was all me. "I’ll do my best," I promised.

While I started getting ready to buckle down for at least a few hours’ worth of laceration repair worthy of Dr. 90210, I sent the nurse in with a morphine shot for her pain since she undoubtedly would have had a hard time swallowing a pill. The nurse came out a few minutes later with a smirk…

"Well, I figured out what she was doing in the club. When she dropped her pants to get the shot in her butt, I found all kinds of cash sticking out of her hot-pink G-string."

I was amused, but in an effort not to be judgmental, I tried to erase that mental image from my brain. But by the time I was repairing her 5th facial laceration, I had been in and out of her room over a 3-4 hour period (alternating between suturing her injuries and continuing to care for all the other patients in the ER), and we had already exhausted all the usual avenues of small talk. Plus, I really couldn’t quit picturing her pink G-string stuffed full of dollar bills… So I went there:

"So, what were you doing in the club?"

"I dance. I’m ‘Baby Phat" and this here," she pointed to her friend. "This here is ‘Sweet Baby’ and we dance together."

"Oh… like choreographed routines?"

"No… there are two poles and we each get on one and freestyle… whatever we think is gonna get us the most tips."

"Oh." You could imagine the mental images I was trying to erase from my brain at that point. This is not a subject I’m used to small-talking about… so I responded with the first thing that jumped into my head:

"I danced on a pole at my wedding."

Baby Phat and Sweet Baby just looked at me. Silence.

Nice one, Whitebread. What exactly are you supposed to say to an exotic dancer without sounding like an awkward mom trying to be cool… and failing miserably.?


2.
The next one is even more classic. This happened 2 or 3 years ago during my residency training at the trauma center. One night the red light outside the trauma room began flashing and in rolled 2 shooting victims. The first patient had been shot by the second patient who had then in turn been shot by police.

The first patient died despite our best efforts. The shooter, our second patient, was luckier and managed to remain stable and awake despite a bullet through the top of his left lung, just above his heart. He had a hemopneumothorax (blood and air in his lung), and as I was preparing to put in a chest tub, many of the ER staff were saying he didn’t deserve any analgesia for the procedure since he had just killed the guy in the next room (allegedly, anyway). That would have been malpractice on so many levels. Of course I numbed him up and made him comfortable. The guy was appreciative because he had heard what the nurses were suggesting.

So, having established rapport with the guy, I proceeded to chat him up in my usual manner as I jammed the chest tube between his ribs and into his chest cavity. "You know, if the bullet had been an inch lower you’d probably be dead right now. Someone has given you a second chance for whatever reason. Maybe you should think about that and make a few changes."

I paused. What exactly are you supposed to say to an alleged murderer? In my case, it was the first thing that popped into my head:

"Like, for starters, try not to shoot people anymore!"

Well-said, Whitebread. Well-said.