Once in a while when Dr X has been at sea too long he has been known to suffer from flashbacks, although some insist they may be hallucinations from all those past night shifts. This incident happened toward the end of his career

This incident happened toward the end of his 35 year career in Emergency Medicine...Time: Late 1990s, late summer, around dusk.

There was a uncharacteristic lull in activity in our ER the busiest private ER in the county. I was on duty in our 30 bed unit with another doctor, a PA, 8 nurses, and 1 unit secretary. It was a slow night.

The nurses were taking advantage of the slack time by talking about their kids, husbands, boyfriends and food. I had just placed a couple of charts in the wall mounted file known as the physician’s wish box. I usually referred to it as the physician’s suggestion slot.

Since the nurses were eating I didn’t tell them tasks awaited their attention. This would have put me at mortal risk by violating the number one physician rule for survival in the ER: Never get between a nurse and her food.

I started to relax, knowing my shift would be over in a couple of hours.
The arrival of Chester, one of our long-time security guards, changed the tone of the shift, decidedly.

“Where’s the doctor?” He arrived at our work desk huffing, Chester was quite corpulent, and shouldn’t have been running at all. He was sweating copiously.

He was also standing right next to me, seeming to have not recognized me. Chester, our security guard.

“Chester,” I waited for him to notice me. “Chester, I’m right here.”

“Doc, good you’re here. There’s a bomb threat against the hospital.” He was still panting, and alarmingly was grabbing his chest. “Who ever is doing this called the police, PD is on their way with all available,” pant, pant, “units.”

Unfortunately, bomb threats against the hospital were quite common, 5 to 6 a year, but we had never had a real bomb go off, and usually one or two cruisers would come over and wait for about an hour, drink coffee, then go about their business.

“We started Disaster Protocol, Doc.” A still breathless, flushed Chester continued. You have to send all patients home that you can.”
Well, Chester was very serious, so I surmised there was something different about this bomb threat and I advised the nurses to empty the ER. We went over each case and determined 4 could go and 6 had to stay, most of the latter were “holds” waiting to go upstairs to be inpatients.

We also went on “Diversion” meaning no ambulances were allowed to come to us. The unit secretary switched her sandwich to the other hand and started calling the ambulance companies and paramedic units.

Through the ambulance entrance doors I saw a police cruiser pull up and stop, lights aflash. Out stepped Captain Wilson, a long time figure in the community with about 30 years of service. We were longtime acquaintances and I had taken care of him several times over the years almost always for work related injuries from custody disputes, we didn’t call them fights anymore, and once for chest pain and hypertension out of control. He was 50 pounds overweight and in addition to hypertension had glucose intolerance and early diabetes. He also had a bad back and two bad knees. I had told him several times he needed to retire.

“Don’t know what I’d do, Doc.” He would say, “All the grand kids are back in Chicago. They’re grown. I didn’t stay in touch like I should have. I could have made the time.” Captain Wilson lived alone and had made police work his life.

He was accompanied by a police explorer who I was sure wasn’t shaving yet.

“Hi Doc, glad you’re on duty.” He began. “About 30 minutes ago we got a call saying a bomb had been placed in the hospital. They said it would go off within an hour.”

“We get those all the time, Dan.” We were on a first name basis, my first name, as usual, was Doc. “What’s with all the fuss?”

“Let’s step outside so I can show you what I did.” I followed, as instructed.

The ambulance entrance was situated in a corner of the hospital that opened up on to the main entrance to the hospital as well as two other sides. I couldn’t see the rest of the hospital campus, but knew it was blocked off by a little league baseball field. We could see everything, every entrance to the 20 acre campus, a total of six. Each had one or two cruisers blocking the way. All with flashing lights. I also noticed most officers had their shotguns out.

This definitely, I surmised, was a notch up on the usual procedure.

“Dan, what’s going on?”

We got a call with an anonymous tip that there was an abandoned car parked on the street with a bomb inside, just one block over on Sunrise Avenue.” So we responded and sure enough there’s what looks like a bomb there on the back seat; real sticks of dynamite, for crying out loud.”

“We evacuated the whole block. We don’t know how it figured into the hospital bomb call, but it shows somebody in this town knows how to make a bomb. I couldn’t take any chances. So we shut down your operation and called for the county bomb squad.”

This would tend to lend credibility to our bomb threat: A real bomb, for a change. I felt uneasy.

I stayed in the ambulance bay, taking it all in. How surreal, the uncharacteristic quiet of a dormant ER behind me. All I could hear was the street noise from Sunrise Avenue as I looked at the cruisers, lights flashing, stationed at the entrances. And nothing was moving on the hospital campus, nothing.

Except from behind a medical office building at the edge of the hospital’s property, at least a few hundred yards away I saw a set of headlights, and they were moving. They were moving erratically, slowly, from side to side, toward Dan and me.

“How on earth did this guy get past our blocks?” Dan’s voice was stressed. He drew his weapon. He looked around for any other officers who could help. They were all too far away to hear us yell, and the weaving car would be upon us soon.

I ran inside the ER and yelled “There’s a car moving toward us, move as fast as you can. Get everyone out of here!”

A raucus of noise erupted, then faded as the last guerney made it out of the ER. All was quiet. The unit secretary ran back in, grabbed her sandwich, then ran out again at top speed.

I looked at the car lumbering our way. Wait, there’s something wrong here. Thirty five years as an emergency doctor had taught me to be suspicious of things that I didn’t understand.

This car was going slowly, and erratically. A real bomber would have made straight to the hospital, quickly, for fear of being spotted and stopped. This car was being driven by an impaired person.

Dan was aiming his weapon at the car’s driver. “Stop the car, or I’ll shoot.” In the fading light I could see the car was a late 70s Oldsmobile, a boat of a car, well dented and scratched.

I told Dan, “Wait, it’s not what it seems. Wait.” He backed away, still aiming at the driver. The car eventually made it to the ambulance bay. Slowly it scraped into a low block wall and stopped, staying in gear, motor running.

The door screeched open and a disheveled middle aged man slid out, ending up sitting on the pavement. Dan holstered his weapon. This was no respectable Bomber.

The car’s driver had a Vodka bottle in his hand. His face and clothes were covered with blood.

It was a patient I had been taking care of for years. Enrique.

“Doc, Doc! Thank God, it’s you. I’m dying, you gotta save me again. Save me, Doc I’ve been throwing up blood all day. I started drinking yesterday. I started bleeding today. Lots of blood, Doc, all over the place.”

“Last time I saw you, you were dry, Enrique,” I said skeptically. “Your wife is going to be very unhappy.”

“It’s not my fault, Doc. I swallowed some mouthwash by accident, and that got me going.” In those days mouthwash was 14 percent alcohol.

“The mouthwash, again? I want to know how you got here, the whole hospital is sealed off.”

He looked around. “Oh, yeah, I wondered what was going on. There’s cops all over the place blocking the entrances. They wouldn’t let me in, I told them I was dying and they wouldn’t let me in. How am I supposed to get in with all these cars blocking the road? So I drove around till I saw that little drive in back of this office building, way, way over there, by the little league field.” He pointed in the wrong direction.

I knew he could drink two fifths of vodka a day. I had taken care of my friend Enrique many a time and so again we admitted him to our ER, gave him a blood transfusion and called an irritable Gastroenterologist to come in and band his esophagus, and of course we asked security to park his car in the “Extended Guest” lot.

So Enrique survived, as did the rest of us and the bomb never went off.

Assuredly, this was a good example of life at its most challenging, recklessly tossing the unanticipated our way. It’s the occasional curve ball that keeps us on our toes and makes us necessary.

Driving home that morning I was impressed with the chanced circumstance it took for Enrique to navigate all that way without being noticed. I mumbled to myself, “Who on Earth would have thought.”

We make rapid decisions in the ER, always with insufficient information and soon learn to resist the temptation to make quick conclusions so we can move on to the next case. Usually it’s best to take time to entertain uncertainty; sooner or later things will start to make sense. The corollary for this strategy is to always be flexible and creative and leave yourself some wiggle room when making any substantial decision. Our patients and staff want us to be right, we mustn’t let them down.

I used to always tell our residents-in-training...Be suspicious of things you don’t understand. If something doesn’t seem to make sense or fit into the scheme of things, if something seems out of place or unexpected, keep your mind open and think things through again. Your ability to solve problems and your experience will come through for you and you may end up finding something unusual that will make you say 'Who on earth would have thought.'

About the Author:

Come aboard as Dr X's Private Sea Journal reveals with great story telling and wit the practice of medicine on the high seas including some of the deep dark secrets of maritime medicine, as well as Dr X.