In the afternoon of a Christmas Eve many years ago, EMS rolled in with a man in distress. He was a small, thin individual, middle-aged, who was clutching his chest in obviously terrible pain, and growling like a cornered animal: “GRRRRRRRRRRR!”
I followed the stretcher to the room. The paramedics had picked him up at home. He had reported severe pain, but he had declined an IV or any medication and had a normal EKG. I glanced at their 12-lead and it was indeed stone-cold normal.
But the patient himself looked like — well, like he was about to die on me. (Aortic dissection? Nutcracker esophagus? Atypical cholecystitis?)
The patient also looked familiar, and as EMS transferred him from their stretcher to our bed, a nurse colleague whispered: “That’s Bobby [not his real name] from housekeeping, right?”
It was indeed. Bobby was a developmentally delayed gentleman who was often at work cleaning the emergency department floors.
“Hi Bobby,” I began.
His face instantly contorted into a terrible grimace, he clutched his chest anew, stiffened in apparent agony, and hiss-growled: “GGGGSSSSSSKKKKKK!”
We all started back in fear. The nurse even cried out something like, “Omigod!”
I was just as alarmed.
“OK Bobby, don’t worry!” I cried, thinking, morphine, the ultrasound machine, another EKG … “Bobby, we’re going to get you some medicine —”
Instantly the hiss-growling stopped, the grimace disappeared, his entire affect changed, and he said calmly: “I think I need to stay home from work tomorrow.”
Tomorrow being Christmas.
“Uh, OK, well, let’s focus on what’s going on right now,” I said uncertainly, thinking, What the heck IS going on?
“So, you’ve been having chest pains?”
“Yes. Chest pain,” he replied.
He looked completely comfortable.
“I think it will get better if I stay home from work tomorrow.”
I tried to continue taking a history but Bobby, almost as if he was impatient with this, suddenly smacked his right hand to his chest so hard that the impact was audible. We all started back again in alarm. He squeezed his pectoralis muscle in a claw-like fist and roared in agony: “GAAAAAAHHHH!” And he raised his left hand to the ceiling, the fingers spasmed and claw-like, as if he was asking the heavens: “Why is this happening to me?”
I was less in control of this situation with every second. To correct that and make myself feel better, I started giving doctor orders: “C’mon let’s get an IV in this guy, and I need the ultrasound —”
And abruptly Bobby was better. (Takotsubo’s? What the heck is this?)
He declared: “I need to stay home from work tomorrow.”
Wait a minute, I thought, belatedly coming up to speed. Is this all about a work note?
“Bobby,” I said, in a tone that mixed annoyance and actual fear, “You know I don’t have anything to do with your work schedule, right?”
Instantly his hand violently struck his chest — with that same audible thwack! — his entire body arched, and he let out his loudest animal roar yet.
For a third time, a roomful of veteran healthcare providers involuntarily lurched backwards, many of us with our own little cries of fear.
This was getting more ridiculous and less plausible with each performance, but somehow each time it was also getting scarier.
“Bobby, stop it, stop it!” I cried. “I’ll give you a work note! You don’t have to go to work tomorrow!”
And he was better.
“Thank you,” he said.
We all just looked at each other.
And then I scanned his chest to prove to myself he didn’t have an aortic dissection.
At discharge he walked out briskly, clutching his papers and waving cheerily. I like to think he had a wonderful Christmas, and I honestly don’t think it mattered one bit that the floors did not get waxed in the ED that day.
A version of this article is also available at Emergency Medicine News.
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