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Brandt's Rants

The Delicious Lunacy that is the ED

Brandt, Robert, MD

doi: 10.1097/01.EEM.0000554290.48405.08
Brandt's Rants



I have found myself periodically laughing out loud (LOLing) during my shifts. OK, that's a lie. No one LOLs anymore. If anything, I am much more likely to have a quiet, understated chuckle. Hmm, that needs an acronym: Quiet UnderstAted ChucKle. A nice QUACK. This may be because after years of insanity in the ED, I have cracked, but more likely, it is simply because I regularly take a small step back from the absurdity and appreciate the delicious lunacy.

Sometimes the simple things can garner a smile.

Me: “Sir, I'm afraid you have fractured your radius.”

Patient: “Oh, but it's not broken?”

Me: “No, it's broken.”

Patient: “I thought you said it was fractured.”

Me: “Broken. Cracked. Fractured. Smasharinoed. Take your pick.”

More recently, timing and complaints that used to upset me make me laugh. The following is all too familiar:

Me: “So when did this pain start?”

Patient: “About four months ago.”

Me: “Uh-huh. And what have you tried for it?”

Patient: “I haven't tried anything.”

Me: “Right. And what did your PCP say?”

Patient: “I never called.”

Me: “So you've had pain for four months, you've done nothing, tried nothing, and told no one. Got it.”

He never tried anything? Seriously, just go to the pharmacy and grab any random bottle or tube or pills. Just try something. Oh, what's that? You drank half a tube of Preparation H for your headache? Well, headache starts with an H so at least you tried! QUACK, QUACK.

Recently, I read an article about discharge instructions. Different providers all over the country had to give the same advice: Please do not inject methamphetamines into your penis. Huh, well, good advice. It was enough to make me have a QUACK.

I recently cared for a patient whose family was confused by a device. Now, in this modern age, not knowing how a certain device works usually carries no shame. My wife often pokes fun at me for not knowing certain tricks with my iPhone. I do, however, have to draw the line somewhere. I mean, as a society, we should be able to assume that the vast majority of the population knows how certain objects work, right? Well, of course, this depends on the object in question. In this case? A blanket.

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You're Not a Lizard!

The interaction went like this: The patient changed into a gown, sat in bed with four family members nearby, and requested a warm blanket. Ten minutes later, they asked for more warm blankets. Time passed, and they kept requesting more and more blankets. A family member called a tech over, yet again desiring more. After 10 blankets, I became confused. It turned out that once the blankets stopped being warm, they wanted more warm blankets and would discard the other ones.

The family members seemed confused when I refused more blankets and told them to use the ones they already had. “But these aren't warm anymore! He feels cold. How will he get warm?” To which I responded that they should leave the blankets on instead of throwing them on the ground once the warmth wears off. They seemed confused. I was bewildered. Had this family never used blankets for warmth? They did not know how blankets worked. Just leave them on. You are not a lizard; your body makes heat!

Sigh. QUACK.

Perhaps the one that will likely continue long into the foreseeable future is having a QUACK at myself. This happened recently when I was trying to explain the flu to a patient. She came to the ED with nausea, vomiting, diarrhea, and mild abdominal pain. She had recently received the influenza vaccine.

Me: “So you've been vomiting?”

Patient (angrily): “That's the last time I'm getting a flu shot ever! I got it three weeks ago, and look at me now!”

Me: “Wait, just tell me what is bringing you in today?”

Patient: “The flu shot, that's what. I was fine for the past two and a half weeks after getting that shot, but now I'm puking all over the place.”

Me: “But... but... but that's not from the flu shot. This is not what the flu shot is for. The flu shot is for the influenza virus, which causes fever, body aches, sore throat, and cough. You have nausea and vomiting. You have no symptoms of influenza. They have nothing to do with each other.”

Patient: “Yup, no flu shot for me or my family ever again!”

I tried in vain to explain the difference between gastroenteritis, the stomach flu, and influenza. My advice fell on deaf ears. Well, at least I could look back at myself explaining the stomach flu and the flu flu. QUACK.

Dr. Brandtis an emergency physician with the Grand River Emergency Medical Group in Grand Rapids, MI. He was the winner of the 2008 Writer's Digest Short Short Story Writing Competition ( Read his blog and other articles at, follow him on Twitter @brandtwriting, and read his past columns at

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