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Tales from the ER #5

Tales from the ER #5

Poisonous Poinsettias & Toxic Show & Tell

“Patient relations is coming over to see you.”
“Oh no, what did I do?”
“They said they’re bringing over a patient.”

Another reason I prefer working nights to day shifts. At night middle management is home in bed and can’t interrupt clinical care. I quickly hid the coffee and snacks that I’m not supposed to have out in the ER and waited for whatever nonsense was coming.

Patient Relations strutted into the ER in her high heels and Dillard’s suit. Accompanying her was a mother who pushed her school-aged daughter in a wheelchair. The girl appeared to be developmentally delayed.

“We’ve had a bit of an incident in the main hospital lobby, I was hoping you could help.”

Patient Relations had vague down to an art form. She probably drafted our CEO’s emails.

“I can try but I’m going to need to know what happened.”
“Yes, yes, of course, can we go to a private room?”
“Are they checking in as a patient?”
“Well, no, maybe you can just examine the daughter first.”

Perfect. The hospital screwed up and we want you to fix it but of course we’re not going to follow the proper procedures and we’d just love it if you as the ER doctor assumed personal liability for this “curbside consult.”

I turned to the mom and asked what happened.

“We were in the lobby waiting to visit my mother, who is in the ICU. Your hospital decided to decorate for the holidays with Poinsettia plants, which are poisonous! My daughter has cerebral palsy and she ate one of the plant leaves and now is having an allergic reaction.”

I turned to the daughter. Indeed, the area around her lips was red and her lips were slightly swollen. Other than that, she didn’t look to be in any distress. Still, potential angioedema is nothing to mess around with.

“Yes, they are poisonous, though not as deadly as you think. Still, anyone can have an allergic reaction. Let’s get her checked in as a patient so I can properly examine her and order some allergy meds.”

Patient Relations looked displeased. While the triage nurse was taking the girl’s vitals she huffed:

“In the future, be careful with how you use the term poisonous.”
“Poinsettias are technically poisonous, though you’d have to eat 500 leaves to die. What you really should be concerned about is the angels trumpet tree out by the front entrance. That thing can actually kill somebody. And don’t ask for my medical opinion if you don’t want it.”

Patient Relations strutted out, her high heels making strange noises on the dirty linoleum ER floor.

The redness and swelling went away with some Benadryl. I put the mom on the phone with Poison Control, who reassured her the daughter was going to be alright. The mom asked me if she should file a formal complaint. I told her yes, absolutely.

“City ER this is Rescue 22, be advised of a mass casualty event at the Elementary School.”

Holy shit. The whole ER fell silent.

“Rescue 22 this is Dispatch. Do you know approximately how many inbound are reds?”

Reds are a disaster medicine term for patients who will die if they do not receive immediate medical attention.

“No reds.”

Now a different voice came on the radio.

“This is Lieutenant Watts, we will be bringing approximately 30 second graders over in several ambulances. There are no casualties per se, they were all exposed to a biologic substance.”


“Lieutenant this is Dispatch, what substance were they exposed to?”
“We believe the substance was heroin.”

The nurses immediately started preparing Narcan, which we give so frequently it’s often kept outside of the locked medication cabinet.

The atmosphere was very tense until the first ambulance arrived filled with laughing, smiling children. Over the next hour several more ambulances arrived with children who seemed delighted with the impromptu field trip. We hooked them all up to cardiac monitors, but everyone was just fine. No need for Narcan.

I asked one particularly animated young boy from the first ambulance what had happened.

“It was show and tell day today! I’m in Mrs. Smith’s class. Actually, it was kinda boring until Johnny got up. Johnny said he was going to show us what his parents make at home.”

Oh Jesus.

“Johnny took out a big bag of white stuff! He opened it and it went everywhere. His desk is a mess now! Mrs. Smith said on the ride over that his parents are bakers and it was sugar. She said I’m here to get my sugar checked out.”

Poison Control advised us to watch the children until the cops confirmed that it was indeed heroin, and not a longer acting opioid. The ER turned into a rowdy second grade classroom, and it was getting near lunchtime. Our social worker ran around frantically trying to call parents, while our clerk tried to convince the cafeteria that yes, we had 30 new patients in need ofjuice and graham crackers, stat.

Johnny was the only kid who wasn’t happy. He asked one of the nurses if we were going to tell his parents what happened. By that point we already knew the police had gone to his house, found a massive stash of heroin and guns, and his parents were in jail. It’s hard to lie to kids, so the nurse didn’t answer and offered him juice and graham crackers instead.