Killing Me Sloth-LY Chapter 1

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Hope

“I didn’t kill him,” an elderly woman quavered as soon as I pushed open the door of emergency exam room #4. “You have to believe me. Are you Dr. See?”

I’ve never had a patient greet me by talking about homicide. My heart stuttered while I gazed down at Ms. Danielle Upton. Even though she stood beside the exam room table in high heels, I still towered over this miniature woman who held out her right, wrinkled hand for me to shake, her eyes wide with trust and a judicious amount of eyeliner.

So. Many. Questions. I defaulted to my usual routine. “Hi, I’m Dr. Hope Sze.” I nudged my wheeled computer workstation inside the room and closed the door behind me, sealing us in with the faint smell of hand sanitizer and disinfectant. Her triage note said only 78 y.o. female, headache 7/10, wants to speak to MD. “I’m the resident doctor on neurology today.”

“Hello, Dr. See.” Ms. Upton shook my hand with more firmness than I’d expected before resting her fingers on the sizeable black purse taking up the bottom half of the exam room table. Her purse matched her simple sheath dress and contrasted with her pearl necklace. “Is that a Chinese name?”

I nailed a smile on my face. “Sure. Please tell me about your headache, Ms. Upton.”

“You can call me Danielle, Ms. Upton, musician, even ‘cat lady.’ I’ll answer to most things.” She smiled and bobbed her head in agreement with herself. “I didn’t kill him. It may look like murder, but it wasn’t.”

“Let’s start at the beginning. Do you have anyone with you who can help tell your story?” I asked while I fought with the computer to open her file.

Usually a caregiver will accompany someone with dementia to the emergency department. Even though I knew it was futile, I glanced around St. Joseph’s Hospital’s white exam room that barely accommodated my computer “workstation on wheels” (WOW), the black exam table, and the sink attached to the wall to the right of the table. Someone had already stolen the plastic chair I could’ve sat on.

“Goodness, no. I’m all alone.” Ms. Upton touched her purse again.

She might look ready for a cocktail party, but she hadn’t known to change into the hospital gown that still lay neatly folded on the table, squashed under her massive purse.

“That can be a problem,” I agreed, still waiting for Sarket, our electronic medical record system, to load her previous charts and help me figure out what was going on. The useless emergency physician who’d referred her had barely written “worst headache of life” before consulting neurology and ordering a CT scan of her head. Ah, the joys of working in a decrepit teaching hospital in Montreal, Canada. “How can I help you today?”

Closer up, Ms. Upton’s lipstick was slightly crooked on the right. “You can prove that I didn’t kill him, of course. But I’ll need to speak to a doctor first.”

“Yes, I’m your doctor. Dr. Sze, remember?” In fact, I’d recently started my second and final year of family medicine residency. In less than twelve months, I’d be fully licensed to go, although I’d applied for the emergency medicine program for another year of punishment.

Ms. Upton blinked at me. “A lady doctor!”

“Yes, we come in XX chromosomes now.” I couldn’t resist making a genetic joke, even if she might not understand it.

She clasped her hands together. “Oh, that’s wonderful. Perhaps you can help me with my murder charge.”

“Perhaps,” I said, instead of jabbing 911 on my cell phone. I’m a doctor. Throughout my training, my job is to stay calm, sort of like the eye in the tornado. First of all, you’re no longer supposed to argue with delusions, just listen and redirect. 

Secondly, even she had shot someone, I’ve witnessed weirder crap in my life. I mean supernatural, never-speak-of-this-stuff like ghosts and dragons. A maybe-murderous grandmother would hardly make the cut.

“Thank goodness.” Ms. Upton wrinkled her forehead at me behind her wire rimmed glasses. If I elbowed her in the ribs, she looked like she might topple over. How could she have killed someone?

At long last, her previous records loaded up on Sarket. Danielle Upton, 78 years old. No recent blood work or brain scans, only a reference to a hysterectomy nine years ago. The Sarket EMR system didn’t connect to other hospitals or to family doctors (of course. See decrepit hospital, above), so I asked, “Did you bring any of your medical records with you?”

“No, I don’t take any medications,” Ms. Upton said, then cocked her head. “I suppose you’d consider me mentally ill for committing a murder. I believe that’s what’s giving me such a headache.”

I began the laborious process of closing her previous file and switching Sarket over to her current medical record. “Why don’t you tell me about that?”

Ms. Upton clasped her hands, her dark eyes still gazing deeply into mine. “I thought you’d never ask. I shot him six times in the head.”

“Hope” you enjoyed the opening chapter to Killing Me Sloth-LY, Hope’s Seven Deadly Sins Thriller 3: Sloth

Grab your early copy on Kickstarter until October 10, either on its own or paired with the art-poetry book Cthulhu’s Cheerleader in Cthulhu’s Duo Exclusive Edition.

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My new favourite medical show

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People used to ask me, “Is ER realistic?” and I’d say, “Kind of.” I only watched it a little, but they cut out the boring bits (“Two hundred! Three hundred! Three sixty!” when resuscitating a patient in VFib who didn’t come back right away, and I was like, “Where’s the CPR? What about the drugs?”) They added human interest elements, like educating kids about sex in the middle of the ER, that just don’t happen for me.

I did like Grey’s Anatomy, but the medical part never convinced me. Once I rewound three times to look at a CT and complain to my husband, “I don’t think it shows a bleed!”

I liked Nurse Jackie the best, but obviously, she was over the top. That whole flushing a patient’s ear down the toilet thing should have tipped you off.

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But Emergency Room: Life+Death at VGH is the real deal.

It should be. It’s a documentary. But this one captures the stories, from multiple angles: the patients, the doctors, the nurses, the respiratory therapists, the social workers. Patients die. (On dramas, so many patients survive miraculously just in time to close out the show, and I kind of roll my eyes.) People and staff aren’t always gorgeous, although I have to say that Vancouver seems to be filled with beautiful people. Crap happens: multiple trauma patients. Multiple bariatric patients. But they also cover less dramatic stories, like a cut hand and a girl with a connective tissue disorder.

On a medical geek level, I really like that the patients give a bit of history, and then the diagnosis flashes on the screen. For me, I can mentally compare my diagnosis with theirs, like a medical game show. I see a knife in the chest and think, “That’s a surgical case,” or I think, “Why would you airlift those fingers?” and give myself a checkmark when they agree with me. And when they show X-rays, the humerus really is broken. It’s not just something the prop people whipped up and might have gotten wrong.

It’s also a great peek into another emerg. I work in two community hospitals, not Level I trauma centres, and even when I did, the Montreal General Hospital was more like car crashes and that sort of thing. VGH regularly handles stab wounds (no gun shot wounds so far, though), ski accidents, and “ped strucks,” pedestrians struck by cars. (Made me realize how much people drive around here, instead of walking, although, to be fair, it’s snowing again.)

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I, too, was amazed by the intensity of their cases. My friend Cara used to say to our friend Anna, who now works at VGH, “Anna, I feel like you’re in university and I’m in kindergarten.” But I was also envious of their personnel and organization. Excellence all the way. “Activate the trauma team.” I am the trauma team. I mean, me and the nurses, the ERA’s until 10 and RT until midnight, but we don’t have dedicated specialties in-house in the middle of the night. We are it. My smaller hospital has only one doctor and one nurse in the ER for the night shift. So if you’re wondering why you have to wait, that’s why.

VGH actually has a protocol for a lock down during violent cases, which sounds like a good idea. And all they have to do is say, “We’re on lock down.”

Emergency Room: Life+Death at VGH also captures the little things beautifully: a shrug, a raised eyebrow, a resuscitation room empty except for a few gloves littering the floor. The jokes (“I had a woman who vomited into her hands and then ate it.” “Hey, why waste it?”) Their philosophies (“I think of the emergency department as a living organism.” One doctor said that working with patients was sacred).

As a writer, too, I love seeing how the show draws you in, spins a story out, and makes you care.

When my kids grow up a bit, I might try and renew my privileges at a tertiary care centre. In the meantime, I’ve got to watch four more episodes of Emergency Room: Life+Death at VGH.