I recently arrived at the ER to see a patient who repeatedly swore at anyone within eyesight, “Listen, you #@%s!!  I want some %##$ing serivce before I rip someone’s head off and ##$@@% this place up.  I’m dying in here!”  From my nook at the doctor’s station I watched my soon-to-be patient as his demands repeatedly met with the exquisite uninterest only an experienced ER nurse can master as they replied with some version of, “You want some Tylenol?”

I felt a twinge of – well, I won’t call it pity, but some sort of desire to get this guy caught up on the New World Order of the ER.  He had the right idea, using swear words to get what he wanted.  But what he clearly didn’t understand was that ER vulgarisms differ substantially from your average, garden-variety verbal swill.  He certainly needed to cuss, but with a decided ER twang.  He wouldn’t even need to yell.

I felt like sidling up to him, kindly putting my arm around him and saying, “Dude.  Tomorrow night, when you show up here again, try this line… I have chest pain.”

Try it.  See how long you wait then.  If you’re still watching “America’s Got Talent” after 10 minutes, use the words shortness of breath and mix in that you’re feeling dizzy and seem to be sweating.

Front of the line.  You’ll be seen in 2 minutes.  Or less.  Putting those words together in an ER is worse than a creative spew of explectives strung out like Christmas lights glowing through the weed-haze of a freshman dorm room.

The truth is that ER staff get sued so often they don’t really have the luxury of thinking much.  They have to react to what they’re told so that if someone dies, they can say they did everything.  Never mind whether or not the claim has any merit to it.  And never mind the fact that a thoughtless workup leads to stratospheric medical costs and just might get a guy some rather intense medical interventions based on a FALSE positive test.  Every test has a statistical rate of false-positivity.  Every time you get a medical test, there is a possibility it will tell you you’re sick when you aren’t.

It’s lawyer thinking that got us to this point, by the way.  Lawyers don’t necessarily understand medicine, but they sure comprehend theatrics.  No doctor wants to try to explain to a jury why they didn’t order cardiac enzymes on some guy who had the drug-munchies reeely reeely bad and also vaguely hinted that he had chest pain when he was told to go find a sammich at the local mission.  So, he gets the work-up (and some dinner).

Watching that guy sitting in the EMERGENCY room with his back pain or a cold or any of a thousand not-actual-emergencies, I could see he had reached his limit.  All he needed was to use some ER swear words.  He may not get his back looked at…but he could just end up with a cardiac catheterization, which I guess is almost as good.  And he wouldn’t have had to wait so damn long for it, either.

Instead, I walked into his room and doggedly launched into my familiar mantra, “Hi Mr.–.  Sorry for the wait.  I heard from the nurse that you have back pain…”