Vitals
God, Sid hated this new vital sign.
Somebody, somewhere in some federal place far beyond his scope had decided pain was a new vital sign.
Sid suspected there had been some congressional hearings and outrage and coverage that got everybody’s shorts in a twist. So now there was this new mandate that the health professions include pain in the vital signs.
Sid loved the vitals. When a nurse woke him up at 3AM, he listened, then asked for the vitals. They told so much. They were vital.
There are only four, until this bullshit of making pain the fifth.
They could all be measured.
Weight. Old guy gains five pounds overnight, his heart, his organs can’t deal with it. Water is what comes and goes so quickly. Save him.
Pulse. Just how fast is that heart beating? Slow means something, and so does fast. But it all is tied to the other.
Respirations. How hard is this struggling patient trying to breathe? The diabetic in ketoacidosis breathes fast to balance the acid in their blood, not for oxygen. The COPD guy struggles always. He slows; he dies.
Blood pressure. Is the heart able to do what it should?
Sid could hear these numbers through the phone and the story the nurse was relating and form a picture. Then he would go see the patient.
Pain was often a distraction. Sometimes it was fear, sometimes real, but real would show in the vitals. So would fear. It doesn’t help to ask them. You have to go look.
But this pain got him out of his garage on a late Saturday on call. He had done the hospital rounds in the morning, seen the sick kids and worried moms in the weekend clinic, so he thought he could fix the speakers in the Hilux in this afternoon.
He’d put them in a while back, now the right side was shot.
The call came. Doctor Hawthorne, this patient has intractable headache pain, and we ask you to come in to see her. Our ER doc has done what he can.
He wasn’t too greasy. Sid washed up, changed into good clothes and went in.
As he passed through the automatic doors, he didn’t look at the waiting folks. He was not their doctor. There was an ER doc in there who would help them. Sid just had to deal with the headache.
Sid had been the ER doc. He knew such a call he had received to deal with a headache meant the problem was beyond what the ER doc could deal with. It was beyond the vitals. Beyond keeping people alive; we now try to keep people happy.
Pain is not happy.
Pain is so much else.
Sid pushed through the doors into the inner sanctum, here where we do our shit. All white in here.
He had been in a kind of head down, do your job kind of posture.
But he caught a glimpse and looked up. There was a little kid on a gurney. A wimpled mom sat small next to him. Maybe ten years old with dark hair and an open face. The big dad in pegged pants and logging boots stood on the other side. The young man looked right at Sid.
So Sid looked back at him. He had dark, piercing eyes. Before him, on a white pillow the young boy had a forearm that bent at nighty degrees right in the middle when it should have been straight. Sid knew this young man had two broken bones.
Sid stopped his trudge and looked at the little warrior who was staring at him. Does it hurt? Sid nodded toward the arm on the pillow. The young man looked at Sid, didn’t look down at his arm. Yeah, some.
Sid smiled at him. The young man smiled back.
So Sid went in to solve insolvable pain.
Insolvable?
You doctors are such wimps. You just blame the patients. You should work harder to understand their pain and alleviate it. So pain can be fear. It can be suffering. It can be other things. It can be an attempt to control a life out of control. None of these problems are solved with narcotics.
Narcotics block pain.
Sometimes we attach all these other feelings to pain. So if the pain fades, so does the attachment. Some. Some remains.
The fear, the worry, the control worry remains, though the pain has gone. This is how we medical professionals have killed so many people. We know how to treat pain. And we can legally give narcotics.
Sid came up to Kim at the nurses’ station, the ER hub.
Little trooper over there.
Yeah, we’re waiting on Ortho and the OR crew to set it. Shouldn’t be long. They’re doing a hip upstairs.
Tell me about my headache.
Kim rolled her eyes. Piece of work. Let Randy tell you.
The ER Doc for this weekend, Randy, came up with his perpetual small smile. Sid, glad you could come in.
Sid covered this ER some weekends for extra money, but Randy did it most weekdays and maybe a couple weekends a month. He lived down in Three Rivers. Sid liked him.
So what have you tried?
Sid was reading her chart and the vitals were normal. She wasn’t puking. She wanted to go out and smoke. Sid could read the orders and drugs given as Randy answered.
Her usual. We haven’t done ketamine or electroshock therapy. Or psychoanalysis. So we called you. Randy broke out into a full grin.
Randy, you want me to shrink this patient for you?
Kim laughed. Please! She needs it. I’m next.
Sid looked down at the spotless vinyl floor. His shoulders fell. He got shorter.
Come on Sid. You can do this, Randy offered. I’ve seen you.
Sid, looking down. I know this lady. She’s a hard one.
But you’re on call. I was so glad that these cycles aligned. You are who she needs.
She hates me.
Yeah, she hates me too. Randy’s smile was back to his normal. We need you, Sid.
Kim was looking at Sid with her most alluring eyes. She tried this often. And she had nice tits. They helped, Sid thought.
So he went in.
She was sitting up on the ER gurney, gown covering her beauty, but her hair and face were still there for her to use. But that was not her tack today.
Why didn’t they get my doctor? I don’t want to talk with you.
Sid still was shrugged down, slumped. He found the rolling stool and wheeled it over next to her and sat down. He looked up at her. Her scorn, her anger was there, looking down at him.
It was hard to see her beauty when she looked at him like that. But he knew it. Sid had seen her beauty so many times. It drew you in.
You are so beautiful.
Shut up! I’m calling the cops. This is sexual harassment!
Sid just looked up at this tortured face with his tired eyes and slumped shoulders. She looked to the far wall. Her profile was beautiful, angry, hurt.
Sid wanted to get up and hold her hand, caress her troubled cheek, smooth her hair, maybe even have sex on the gurney. But he just sat and waited.
She finally looked back from the blank wall. She looked down at him. So what the fuck am I supposed to do?
Sid smiled at the beauty above him.
Kim asked, how did you shrink her? We couldn’t get her to leave.
Sid was doing his documentation, so he ignored her kind of. But he did smile as he hunted and pecked.
Randy flashed by. Strong work my man. Big grin. Rare from him.
Sid looked up at Kim, still looking down at him. What the heck.
I told her I loved her.
You did?
Yeah. I love you too.
She laughed so hard.
Sid left back to the broken speaker.
This is on my "chore" list - along with adding the pictures that didn't come over from Blogger. Click on Dashboard, scroll way down to Settings, then select Sections in the Content area - about half way down. Click Add button. When done, Save. Moving your older posts into a newly created section isn't easy - yup, you have to update them one by one. Thankfully, the process is incredibly quick and will not re-email your subscribers if you do it correctly. Here how to update your existing Sid archives: 1.Go to your Posts dashboard: Dashboard view. Log into your Substack dashboard and click on Posts in the top navigation bar. Make sure you are on the Published tab.2.Open the post settings: Find your old post. Locate the post you want to move. Click the three dots (...) next to the post title and select Edit post.3.Access the publishing settings: Inside the editor.Once you are inside the post editor, look at the top right corner. Instead of a "Publish" button, you will see a Settings button (it looks like a little gear icon). Click it.4.Change the section mapping: The key adjustment.In the settings sidebar that slides out, look for the Section dropdown menu. Click it and switch it from your main publication (or whatever section it was in) to your newly created topic section.5.Save without re-sending: Crucial final step. Click the Update or Save button at the bottom of the settings pane -mine was Continue first. Important: Substack will simply save the changes and update its position on your website. Because the post is already published, it will not trigger a new email notification to your readers. Once you hit save, you can immediately visit your public homepage, click on your new topic tab, and you'll see the old post sitting right there in its new home.