A wait in Emergency,
Janos, 'Million-Dollar Man'
The admissions area of the Emergency room at Toronto Western Hospital is crowded again tonight. Toronto General Hospital's Emergency room remains closed with an outbreak of Norwalk virus and TWH is taking the extra load.
Last night my wife and I came by ambulance. When you arrive in style like that, you get to jump to the front of the queue at the Triage desk. Tonight I drove, so we have to take a number and wait, as if we're at the deli counter.
We're number 47.
We're only two numbers above the 'currently serving' display, but the duty nurse is nowhere to be seen so we may be in for a long wait. My wife is deathly pale and in serious distress, but there's nothing for it but to sit and hope.
The emergency area seems retrofitted from another purpose - possibly a temporary measure during TWH's multi-million dollar facelift. The waiting area is furnished with a mixture of cast-off single, double, and triple seat chair sets in different colours and materials. One half of the room is actually a former lobby with the double sliding doors taped off and the electric eye disabled.
Another corner area is half-heartedly walled off with beige office baffles. In the top corner a 12" TV natters away for the amusement of the bored security guard. The TV is showing Aliens, but the viewing area's seats are dominated by an extended Asian family and their sacs of McDonald's offerings. It's better than last night's Ultimate Chopper infomercial, but I'm not in the mood for the adventures of Ripley and company at the moment. At least it's not Alien -- watching Kane thrash about on the mess table would have hit a bit too close to home.
My wife and I take a pair of seats on the other side of a baffle and settle in. I watch her bent almost double to try to cope with the pain, and I worry.
Paramedics arrive, with a young woman who looks like another Norwalk victim. They pull her stretcher up at Triage and wait for the duty nurse. There's something about the pumpkin-orange blankets they put on patients that gives a bit of colour to the cheeks of the pale and trembling woman as she sobs in the stretcher bed.
The duty nurse passes through to deal with the paramedic's patient. She's the same nurse we saw during the later part of our first visit yesterday. She's perhaps in her early thirties, with a positive yet professional attitude. Her Rubenesque figure fills out her blue scrubs nicely, giving just a hint of no-nonsense strength in case of trouble, but with her blonde shoulder-length bob taking any possible edge off things. She takes a moment to tell us that she remembers us from last night. That may help us a bit when our turn comes. I try not to resent the woman on the stretcher as she's wheeled to the emergency
I know the next scene by heart from the night before. The guard tells the paramedics to rinse their hands with a squirt from the alcohol-based gel dispenser by the door. One of the paramedics demurs. The guard insists. Norwalk protocol. No exceptions. The paramedics strip their surgical gloves and rinse as instructed, and then the guard wheels them in. Oddly, patients are exempt from this little ritual -- even though everyone else must rinse before entering or exiting the emergency room proper.
A new batch of paramedics arrive. On their stretcher is a short, stocky, and slightly greasy looking man. His legs are strapped in but he's sitting up. His dark windbreaker and green MEC backpack sit atop his legs on the bed. He looks about him with no apparent signs of distress. The duty nurse returns to the triage desk and comes out to size up the new arrival. Paramedic #1, a tall young fellow with a bodybuilder's frame starts to tell her about that the patient was found on the side of the road having a seizure. She waves him to silence distractedly. "Hello, Janos." she says to the patient. He smiles at her guiltily,
like a little boy caught sneaking a few extra cookies. Paramedic #2 snorts in amusement. "You know this guy?" asks #1. The nurse nods. "Have you been drinking, Janos?" she asks him. "No!" Janos replies. "No, no, no!" he insists loudly.
The nurse and paramedic #1 discuss Janos. As they talk Janos yells at the nurse. "You lovely woman!" he tells her repeatedly. "Where'd you get him?" she asks the paramedics. "King and Parliament." says #2. "You were almost home, Janos." she tells Janos. Janos grins. She ignores him while they decide whether he needs further attention. Janos starts to shake in a convincing epileptic seizure. "Stop it, Janos!" she tells him sharply. He stops in mid-shiver and grins at her. Paramedic #2 snorts again. Finally they wheel Janos back into the emergency ward. Janos insists on rinsing his hands as they go in. I think dark thoughts.
A stocky young man in his early twenties arrives. He sits next to me, and tells me how he thinks his shoulder is dislocated. Apparently he was in a bar minding his own business when a fight broke out. He got involved for some reason that I didn't quite catch. Then the 'cops' arrived, and proceeded to 'beat the hell out of him.' He conjectures that his 'skulls' tee shirt and leather jacket set the cops off, since he certainly didn't do anything. Of course not.
The duty nurse calls us, interupting my seatmate's sad story. She sees us in the triage exam room, and notes the pertinent details of my wife's case, including our visit last night and discharge only 10 hours previosly, and the complete failure of the prescribed Tylenol 2s to alleviate her pain. We'd come originally to request Tylenol 3s but my wife's skin has taken on the grayish tone typical of a Vaso-vagal response and clearly something is seriously wrong. The duty nurse tells us we have priority for a bed as soon as one becomes free, but that there are no free beds in emerg. at present. Great.
We are formally registered and my wife gets her second TWH wristband in 24 hours. Back to the waiting area we go.
A brief rush of new patients arrives to fill the waiting area to overcapacity. A police officer arrives with a tall, handsome black man whose good looks are marred by the hasty bandage at the top of his temple and the bloody crease along the left side of his scalp. It looks to me like someone let him have a good wallop with a tire iron. Also new is a very sad looking old man holding his stomach in his hands. A pair of early 40s women in what appears to be biker/cougar chic stroll in, laughing and chatting happily. The more heavyset of the pair is covered in blood down the front of her lamé tee shirt and jeans, and is
holding an ice bag to what can only be a serious head injury. Everyone takes a number and waits with calm patience, chatting as if it's a resort lounge. My seatmate tells the cop the same story he told me, with no sign on animosity.
Meanwhile the Aliens are inside the perimiter. The TV inflicts riotous gunfire on the Asian family as they try to sleep.
The tall dude with the lug nut shaped divot in his forehead was the victim of a home invasion at his rooming house. He has a strong Jamaican accent and a deep Barry White voice. I think idly that this guy must be quite the ladies' man on nights when he's not hanging out with Toronto's Finest at TWH ... he's got it all, including an easy charm as he tells his story. "I tol' her a hundred times, mon, lock the side door, but she never do it." he says. It turns out that a group of men broke into the home and attacked the landlady. Our hero tried to intervene and got thanked for his efforts with a little blunt instrument trauma. He's very philosophical about it.
The party girls have sauntered off arm-in-arm to the washroom, apparently to scrub off a bit of dried blood. I wonder if my first assessment of them as cougars was a bit off the mark, but I don't get to hear their story. There sure is a lot of blood on the injured one, but she seems curiously unconcerned.
I am amazed at how calm everyone is. If I was in emerg. with head trauma and nobody was helping me I'd be a bit on edge. Then again, my wife is now the colour of newspaper and here we sit quietly. What else can we do?
More cops - a young eager looking constable with a blond crew cut struts up to the counter. He looks like he learned his moves from Officer 'Ponch' of CHiPs as a boy. "Got a drunk for you!" he cheerily informs the nurse at triage - a younger, African-Canadian woman who seems to be spelling off the duty nurse at the moment.
He tosses a dark windbreaker and a bag to the floor by the desk, commandeers a wheelchair and sails back out to the squad car. Something about the scene strikes me as peculiar but I can't place it.
A moment later he's back, along with his partner and their 'drunk.' Handcuffed and seated in the wheelchair is none other than Janos. Constable Crew Cut grabs the MEC knapsack and starts rummaging in it. "No!" Janos cries. "No, no, no!" but Crew Cut ignores him. He produces a poker hand of blue hospital ID cards, and selects one as if performing a magic trick. "This one's yours." he tells the Triage station nurse.
Crew Cut chats with a paramedic crew for a few minutes. Janos continues to protest but is roundly ignored. Then the duty nurse returns. Crew Cut starts to explain about the seizure their prize was having when they picked him up. She ignores him. "Back again, eh, Janos?" she asks. Janos gives her his little boy smile, and then proceeds to complain about the policemen. It's not very coherent but the cuffs are clearly unwelcome. The duty nurse tries to get the police to take Janos home, but Crew Cut refuses. Janos has to be examined. "The desk sergeant will kill me if I don't have the paperwork." he says. They argue, but Crew Cut wins. Janos sails past us for the second time. He wants to rinse his hands but since they are cuffed behind him he has no luck this time. I resent Janos, Constable Crew Cut and his desk sergeant with equanimity.
A bed frees up and they take my wife in for assessment. I'm not allowed inside because of the Norwalk quarantine so I watch her shuffle down the hallway. The woman with all the blood on her went in sometime before us. Barry White's still waiting, as is the sad old man. Dislocated shoulder guy got handled sometime in there and is gone. The Asian family has been taking shifts but nothing seems to be resolved for them yet. The duty nurse tells me it'll be hours before my wife is assessed, and I might as
well go home. I've been awake for almost 40 hours so this seems like a good idea.
My wife gets a bed near Janos. She reports that he runs his seizure routine a few times, and then checks surreptitiously to see if anyone's watching. If not, he stops. He also is messily sick at least twice, both times contriving to miss the bowl given to him to collect vomit. Each time he draws the attention of two nurses plus a maintenance person who has to clean up the vomit. Janos spends the night in emerg., surrounded by people who know him by name, while sick and injured people continue their lonely wait in the lobby.
My wife goes for a CT scan. The problem is finally determined, and she goes for surgery later that day. She's recovering now, and that's about all we'd like to say about that.
Friends in the medical profession tell me that Janos is a specimen of the so-called 'Million dollar man.' Over his lifetime he will engage over $1 Million worth of emergency care resources. Not only does he deprive others of that care, but he could probably be enrolled in programs that would get him off the streets and into society for a tenth of that cost. But nobody can force him, and he's got a schtick that gets him a warm, dry bed whenever he wants it. Not for nothing does he have a card from
every major hospital in Toronto.