December 30, 2006, 11:50 am

Unmitigated Gall, And I Don’t Mean Bile


Aw, man!

I see this two days after Christmas.

I want this doll and I want her bad!

They gave her a stethoscope!

And a totally freakin’ cool cap!

They made her shoes look like flats instead of pumps!

(You can’t blame Barbie for wearing pumps. She has spent the last 45 years wearing high heels and has horrible foot-drop.)

She probably has plantar fasciitis and has to wear heels.

Oh, and by the way, this is exactly how I look at work, every day!

I kid you not!

I look exactly like this until I happen to glance into a mirror and see reality staring back at me, but until I do this is me!


My little Mac widget dictionary/thesaurus (which I cannot live without) defines “gall” as “bold, impudent behavior”.

Once upon a time a patient was talking on her cellphone while sitting in the gurney awaiting evaluation by the ER phsician.

She glances up and keeps on talking!

The doctor stood at the bedside, hands behind his back and stared at the patient.

She kept on talking! The conversation wasn’t even related to her ER visit. If I remember correctly, it was gossip about last night’s dinner companion.

The doctor pulled up a chair, sat down, crossed his legs, folded his hands and continued to stare at the patient.

She kept on talking!

After ten minutes, she ended the conversation and turned to look at the doctor, who promptly informed her that (1) she had talked through the entire time he had to evaluate her, and that (2) she would have to move to the back of the queue before he would be able to see her again.

He left the room.

She looked at me.

I said something about “blowing it” by talking on her cell phone when the doctor was at the bedside.

“Well it would have been rude to just hang up!”



Fast forward a bazillion years.

Father brings in son in the middle of the night for a fever. They are welcomed into the triage room.

The nurse begins the assessment. The cell phone rings. It’s grandma, wanting to know what is going on. Never mind that the kid has only been gone from the house for five minutes.

The nurse politely waits for the father to cut the cell phone call.

He doesn’t.

The nurse politely asks the father to stop talking on the cell phone so the triage assessment can continue.

The father lays the cell phone down but does not hang up! The nurse asks a couple more questions regarding the history and the father picks up the phone and starts talking again!

The actual physical exam was next and febrile screaming toddler would have none of it. As the nurse tries to ausculate the lungs the screaming, febile screaming toddler is hitting the nurse in the face and all the nurse can hear though febrile screaming toddler’s chest is the father’s voice.

The nurse sits back and waits for a break in the conversation to ask father to hang up.

It never comes.

She decides to assert herself anyway and ask the father to hang up the phone so that triage may continue.

Father nods his head and keeps on talking.

The nurse ever so subtly brings herself up to her full height while siting in the chair, ever so slightly elevates her voice to an authoritarian timbre and informs the father that if he does not hang up the phone now, this triage session will end until he does.

The father pouts (actually pouts!) and hangs up the phone.

“Well she is concerned!” he explains.



  • universalhealth

    December 30, 2006 at 1:17 pm

    Priorities. Out of whack.

    Fear. Loss of face. Loss of control. Fear of death.


    Happy New Year, Kim! Love the blog and love that I FOUND your blog! Thanks for all you do and how you do it, and may comfort and joy be yours and your friends’ for the year ahead!

  • DK

    December 30, 2006 at 1:41 pm

    My wife had a kidney stone that landed us in the ED a little before midnight. The ED was full so, since she wasn’t actively dying, we were placed in a triage room until she could be seen. Since this was next to the triage desk, we got to hear all kinds of interesting things going on outside.

    1) A guy had been hit by a car. He had a broken arm and a broken leg. His main concern? His cell phone battery was about to die and he wanted a charger. He was asking everyone within earshot if they had a charger for his phone. I was about ready to walk out and hand him my phone to get him to shut up.

    2) A woman comes in saying her son was here as a result of a gang fight. She wanted to see him and began to wail uncontrollably. When the staff asked her what her son’s name was she became combative and started screaming. Upon attempting to force the door to the ED hallway open, security was called. While screaming and flailing and fighting with security, her phone rang. Suddenly, the woman was calm and quiet and having a normal conversation on her cellphone.

    Cellphones have a strange effect on some people.

  • Mama Mia

    December 30, 2006 at 2:02 pm

    Yes, I’ve experienced exactly that sort of triage. Inordinately frustrating. Makes me want to smash the phone. Just how concerned about your illness are you?

  • Lillian

    December 30, 2006 at 3:13 pm

    Great Barbie, but oh so terribly expensive. 🙂

    As for the whole cell phone situation – can’t cell service be cut in the hospital, or have signs posted that say cell phone use interferes with equipment (even if it doesn’t)? My final solution would be to create a cell phone zone, similar to a smoking zone, with all other areas of the hospital of limits.

    Great blog by the way Kim! Best I’ve ever read.

  • Andrew

    December 30, 2006 at 5:33 pm

    It should be like the airport, where you check your bags before your flight… check your cell phone before your ER visit. Quite simple actually.

  • laura

    December 30, 2006 at 5:38 pm

    can i borrow your cape sometime?

    one night nicu is called to attend the delivery of a patient with a non-reassuring fetal heart tracing.
    the team arrives as an obviously exhausted mom is pushing for all she is worth. mother is surrounded by her support people: her mother, auntie, two sisters, “fiancee”, his sister, mother’s three best friend.
    OB and OB nurse are talking, encouraging and even supporti ng mother as she continues pushing.
    support is gathered in semi-circle around the foot of the bed with camera phones open taking pictures of mother’s 8 lb 9 oz baby boy entering into the world.
    after brief stimulation and 15 seconds of blow by O2 offered by the nicu team, baby boy pinks up and cries vigourously. apgars n up being 9 and 9. mother is crying joyfully and begging support to take some pictures of th beautiful ba by. alas no one seems to have anymore memory and can not take any pictures.
    nicu nurse sarcastically suggest perhaps some of the crotch shots be deleted to have room for pictures of the baby.
    mother practically sits up as OB is still stitching mother and tells support in very colorful terms to delete those pictures now.
    nicu nurse resolves that she will confiscate all camera phones when her daughters are delivering her grandbabies.

    another night nicu team is called to attend delivery of baby with late decels. the team enters the room to find a mother lying in bed moaning and doin nothing more. ob, nurse and grandmother are trying to urge mother to sit up and push wih the contraction. mother weakly moans and writhes whimpering that she just can’t.
    suddenly grandmother’s cell phone rings. of course grandma must nnswer it.
    that poor, weak mother who had no strength left in her to go on suddenly sits up in bed, sceams at her mother to turn the f-in phone off. granmother shuts the phone off.
    during the moment of silence in the delivery room, nicu nurse suggest that maybe grandma should leave the phone on. mother looks at nurse and asks why. nurse replies because with the energy she had to sit up and yell at grandmother she would have pushed that baby out in no time flat.
    yes, mother is a little mad.
    next contration comes, mom sits up an pushes with all the effort she can muster. three pushes later a 6lb 14 oz baby boy is delivered.
    tears of joy all around.
    as baby is placed in mom’s arms to bond she tearfully thanks everyone, including grandmother and nicu nurse telling them she couldn’t have done it without them.

    one comment about the sign saying no cell phones. they are everywhere and it is espeially sweet when a “concerned” family member is yakking on the cell phone while staring at the sign.

  • Sid Schwab

    December 30, 2006 at 7:25 pm

    When I walked into the exam room and the patient was on the phone, I’d give them a moment to end the call. If they didn’t, I left, saying “let my nurse know when you’re off the phone and she’ll see if we still have time to see you…”

    It’s amazing that a thing that didn’t even exist a few years ago has become attached to people’s heads.

  • jen

    December 30, 2006 at 7:56 pm

    barbie is about to get a “note to file” because her hair is down and touching her shoulders.

  • Erica

    December 30, 2006 at 10:01 pm

    I sit here shaking my head in commiseration. It never ceases to amaze me how many people insist on talking on their cells despite all the signs we have hanging up that say “No cell phone use in this area.”

    I’m so impressed that your doc had the resolve to sit there through the entire conversation without punching the patient. Most of our docs do what I do: enter the room, see patient on the phone, and if the next 10 words out of the patient’s mouth do not include “I’ve gotta go, they’re here,” mouth the words “I’ll be back” and then disappear. The subtext of that “I’ll be back,” of course, being “when I get around to it.” And then, to the bottom of the list they go.

    Isn’t it interesting how we can tell so much about how *not* sick a patient is by little things like cell phone conversations, Dorito-munching, whining about getting a dinner tray ordered, laughing and joking with concerned visitors, et al. ??

    (big sigh)

    Keep up the good work, woman! And Happy New Year!

  • Too Fat, SN

    December 31, 2006 at 12:42 am

    I love the way you and the M.D. handled the cell phone issues. If you get the time there is a wonderful video on YouTube showing a college professor in the middle of lecturing snatching a cell phone (in mid conversation) from a student and smashing it to bits!

    I realize we can’t do that as health care providers but… it would feel soooooo GOOD!

    Too Fat, SN

  • Ursa

    December 31, 2006 at 9:30 am

    Oof. Cell phones. A few years ago i ran a poster store, and my coworkers and i used to daydream about putting lead shielding in the ceiling to block cell signals in the store. It wasn’t a huge deal to have customers wandering around the store on the phone, most of the time, but the ones who’d come up to the counter and ignore us (other than to literally throw money at us) as we rang them up used to piss us off to no end.

    Sadly i’m pretty sure that if we’d tried to wait until they were done talking, we’d never be done. Stupid cell phones.

  • Mel

    December 31, 2006 at 3:58 pm

    I have a cell phone, but I only talk on it (or any other phone) when there’s a person in front of me needing my attention if it’s a family emergency. Otherwise, the phone gets put on hold. Unless a co-worker walks up at the precise minute my 20 minute wait on hold ends, but they’ve all been there too and totally understand. 🙂 Certainly, if I had gone to the ER, I or my kid would *need* immediate medical attention and I wouldn’t talk to anyone else once it arrived.

  • Kerri.

    January 1, 2007 at 9:05 pm

    Kickin’ Barbie.

    And that guy with the cell phone should have been flogged with an IV tube. Until he cried. 😉

  • Steve

    January 2, 2007 at 11:24 am

    Wouldn’t it be neat to see if there is a corolation between cell phone use and expectations patients have of the emergency department? I mean if they are rude enough to be on a cell phone; it seems they may have unreasonable expectations for the emergency department.

  • Tom

    January 3, 2007 at 11:41 am

    Mom brings a child to the ED with a complaint of “fever” when asked what the last temperature was the response is “I don’t know, don’t have no thermometer”. have you given the baby any Tylenol, “no, can afford no medicine”.

    Exam: Temp 103.2, R TM red and bulging;
    Dx OM
    While explaining the Dx/Rx to Mom her purse begins to make a funny noise-She opens her purse to grab her cell phone, which was under her cigarettes!

    How will national health help this sad social situation????

  • StudentNurseJack

    January 3, 2007 at 9:26 pm

    As a student, I’ve had a couple of instances in which my patients have been on their cell phones all. the. time. Which makes it difficult to obtain a thorough assessment complete with patient history. One of them was irritated that I had the gall to ask him to interrupt his call so I could ask him if he wanted pain medication before his physical therapy session per his prn orders.

    I’ve often wondered in many different settings why people forgot their manners when cell phones became our primary way of reaching each other. I love them, and I hate them.

  • Crazy Working Mom

    January 4, 2007 at 1:15 pm

    Very funny stuff!
    Great post.

  • Jennifer

    January 6, 2007 at 7:33 pm

    I love it – I love it – I love it!!! So proud of that doctor!!! And you too, for pointing out how it was her own fault!

  • MarillaAnne

    January 11, 2007 at 11:12 am

    I liked it so much I included it in my Thursday Thirteen #5.

    have fun,

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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