When I arrived at 7 p.m. to start the night shift, I followed a trail of blood into the hospital entrance where it continued right into emergency bay 3. There, I met a 30 year old man named Rick who was lying in the gurney bleeding from multiple stab wounds to his arms and stomach. Rick wouldn’t say what happened. He demanded a needle and thread so that he could sew himself up at home. While cleaning his wounds, the nurses patiently convinced Rick that we would do a better job sewing him up if only he would stay awhile. Rick was silent for a moment and then nodded his head in agreement. However, when the patient registration clerk came in and asked Rick for his last name, he refused to give any more information and threatened to leave again. Resigned, the clerk was forced to put the name Rick Doe on his chart.

Later, imaging studies confirmed that Rick’s wounds were superficial, so I injected anesthetic into the multiple wound edges and started sewing them closed. To my dismay, my work was only half done when three policemen charged into the room and started drilling Rick with questions. In response, Rick jumped up from the gurney and tried to run out of the room, sending instruments flying.

I wasn’t sure what Rick had done, but I did not want him to leave the ER still bleeding. A standoff developed among the officers and me. For the next several minutes, we played an almost-courteous tug of war while I insisted that I needed 15 minutes to finish my job. Finally, they reluctantly agreed and planted themselves just outside the door of his room.

For added privacy and calm, my medical assistant, Ana, slid the glass door closed and led Rick back to the gurney. Relieved, I once again opened up a sterile suture pack and put on another set of size 6 gloves and got back to work.

As we worked quickly to close the rest of his wounds, Ana started to lecture Rick in the stern tone of a mother towards a wayward child. She advised him that he should be quiet and cooperate with the officers, and maybe he could avoid being arrested. That advice only enraged him further.

“ I know my rights; it’s not a crime to come to the hospital for treatment!” he hollered at top voice.

The raucous shouts brought the 3 officers barreling back into the room again. They continued to question Rick for details of his “crime” while I closed the remaining gaping wound in his arm with the last four sutures. It was obvious to Ana and me that Rick could not control his anger and that he was inflaming the officers with each retort. Despite that glaring fact, Rick with no last name was beginning to grow on Ana and me, maybe because we had been wrestling with his outer crust for an hour and somehow softer tissue was peeping through his harsh exterior. Whatever the reason, Ana and I found ourselves pinching,poking, and nudging Rick under the guise of bandaging his wounds in a futile attempt to douse his uncontrolled anger. Ignoring our pinches, Rick continued to hurl insulting responses at the now impatient officers. He also snarled at us to lay off.

We did just that. Moments later, we watched with sadness as three weary officers placed silver handcuffs on Rick’s wrists, carefully avoiding his freshly closed wounds covered with clean white bandages. Amazingly, they led him rather gingerly out of the ER, their eyes avoiding mine. However, before the glass doors slid closed, I heard Rick mutter:

“ Y’should of given me a needle and thread. I just wanted to go home.”

Dave was lying in the gurney in bay 4. I didn’t know why he had come to the ER and neither did anyone else. He came by ambulance at the beginning of the night shift, without any family or friends, and the paramedic report stated that he was a 73 year old man with no complaints. Apparently he was staying with a caretaker over the weekend while his son was gone, and she had called the ambulance. When I went to examine Dave, he seemed a little frail and slightly confused, but otherwise I could find nothing wrong with him.
Concerned, I asked him why he had come to the ER at all.

“ I don’t know,” he replied. “ There’s nothing wrong with me.”

Without any clue as to the reason for his presence in the ER, I decided to order a standard battery of tests including blood work, a chest x-ray and EKG. Then I called the number of his caretaker. In a disinterested voice she reported that Dave had complained of chest pain earlier in the afternoon, but his symptoms went away after about an hour, so she had decided not to mention it to the paramedics.

Ten minutes later, I heard an urgent shout from the X ray technician.

“ Dr. Rosen, you are needed in bay 4!”

I felt my heart pounding as I raced back to Dave’s room. He was lying there, completely unresponsive. He had suddenly stopped breathing after the technician had taken his portable x-ray.

“ Call a Code Blue!” I commanded tersely, as we wheeled him into the trauma bay to start CPR. The resuscitation team members arrived quickly from all areas of the hospital and we all worked together to bring Dave back to life. Although we continued our resuscitation efforts for over 20 minutes, the actions were futile. The cardiac monitor showed a flat line: his heart had no electrical activity. I had the feeling that Dave had decided to go, and there was no one here to persuade him to stay.

During the Code Blue, the ward secretary urgently started her search for family members to contact. She also tried to contact his caretaker, but her phone was off the hook, according to the operator whom she contacted for an emergency line break in. Several hours later, the caretaker finally answered the phone. When I informed her of Dave’s death, her only comment was,

“ Oh my God. Please don’t tell his son until tomorrow.” The caretaker refused to give me a contact number for his son until I threatened to call the police. We dialed the son’s number again and again, but no one answered. Finally, after leaving multiple messages on an answering machine, we transfered Dave’s body to the nearest morgue.

Dave often came into my thoughts that night, until three in the morning when another 73 year old patient came in to the ER. Her name was Anna, and she was accompanied by her very worried husband and daughter. Anna had been ill with heart problems for many years, and also suffered from mild dementia. When Anna came in, her heart rate was over 160 and her lungs were filling up with fluid. She was very weak and was having difficulty breathing. I explained to her family that her condition was very critical, and that her chances of dying that night were great.

During the next few hours, Anna teetered on the brink of death. We continued to administer drugs to slow down her heart rate, and to help to clear the fluids from her lungs. Anna’s husband stood at her side the entire time. Although she was too weak to respond, he held her hand and talked to her, begging her to stay with him. As I looked at his adoring expression, I realized that Anna’s husband did not see a weak and deteriorating old woman in front of him, but the beautiful young girl that he had fallen in love with.

At six in the morning, Anna’s heart rate returned to normal, and she was breathing easily. Although she was still weak, she smiled at her husband and sipped a little water. Against all odds, she was going to live. I reflected again at the power of love. I wondered if her husband’s love, as much as potent medications, had kept Anna alive through the night.

Sometimes truth really is stranger than fiction. At the end of our shift together, the ER staff debated over which was the most bizarre story of the weekend. The first contestant was the 17 month old boy who came to the ER with the deer antler lodged in his forehead after it fell off the wall of his father’s study. After holding him down and injecting him with lidocaine anesthetic, we removed the antler pieces with surgical tweezers and a lot of flushing. He left the ER "sans horns" with a neat row of sutures.

The second contestant was the man who sliced open his scrotum while he was jumping over a fence. According to his account, there was a broom on the other side of the fence that caught on his pants and broke in two when he landed on it. As I stitched him back together I couldn’t resist asking,
" Are you sure it was a broomstick?”

After our debate the vote was split 50/50. What's your vote?