#orneryjen

This is a work of fiction.

I'm a registered nurse who works at the Critical Care Unit of a busy level II trauma hospital in the Southwest. My typical shift starts at 1900 in the evening to 0700 in the morning and my typical "customers" are a motley sort:  "Homie" drop-offs (wounded gang members dumped right at the ER curb by their "friends") with gunshot wounds fixed with chest tubes and vacuums draining their lungs. Nursing home elderlies, neglected and festering deep in sores and feces. Frothy overdoses, mangled motor vehicle accidents, cardiac arrests, alcohol withdrawals, schizophrenic wig-outs, customer service complaints…you get it.

A bruised and nervous woman staggered into the ER. This wasn't the first time she showed up in the odd hours of the night. She would check with complaints of various sorts. A head bump. A twisted arm. A broken tooth. A stubbed toe. And on cue, her sobered husband would show up hours later demanding to see her. And once he was by her side he would hover on her every word. Coddle her. Taunt the staff. Raid the patient food fridge. Then he would demand they leave for home....only for her to return a few evenings later.

It was a pitiful cycle of spousal abuse and we did everything we could to get her to press charges. We left post it notes as she went to the bathroom, dropped cues in our conversations with her, arranged numerous social services consults, and even tried to isolate her from the husband. But she denied the signs, brushed off the police, and clung to her husband like a prince. And the more she kept coming back, the more pissed off we became. Our hands were tied.

I was on shift when she came in with a chief complaint of a sore throat this time. Wide red bruises wrapped around her neck; the telltale signs of manual strangulation. Unlike her previous visits, Dr. O'Neill (a young female resident) decided to admit her in the hospital for a day or two.

The husband exploded. "The fuck she's not staying in here!"

"Strangulation to the neck causes throat swelling and an increased risk for suffocation. We'll b treating her with steroids and monitoring her should the swelling get worse."

"She's stupid and clumsy, yo! She fell and hit the counter. That's what she did!"

"That doesn't match the injuries to her neck."

"Bullshit, she's fine!"

Dr. Stevens, lead doctor of the ER, approached the couple and tapped Dr. O’Neill by the shoulder. "There's an old lady with a head lac in gurney five. I'll take over."

Dr. O’Neill sighed, shaken but relieved. She took the chart from his hands and marched to the next exam room. But not before shooting a sarcastic gaze: good luck with this one.

The lead doctor smiled at the couple and introduced himself with a chirpy voice. "I'm Dr. Stevens, I'll be taking over your wife's case." Dr. Stevens had recognized the wife numerous times but never treated her. Until now.

"Finally! A real doctor,” the husband scoffed.

Dr. Stevens held out a cup of water and some Tylenol. "First of all, you're cranky and I'm hearing you're having a headache. I want you to take this and get that taken care of."

The husband snatched them with a swig and a gulp.

"Now that I've introduced myself, can you tell me what's going on?"

"Yeah," the husband interjected. "She fell on the floor and her sweater got wrapped up in her neck. That bitch doctor wants to keep her here. I ain't paying bills for that."

The doctor stroked his beard for a moment. Then he turned to the silent wife. Her head was bowed under her hoodie.

"Is this true?"

She feebly nodded. Or tried to.

"I can't hear you."

"Yes," she said hoarsely.

"Oh good. You can talk."

"Yeah, cause she won't shut up," the husband berated her. "Next time, you listen exactly what I say, babe. Or this shit happens again."

"Why! You're exactly right!" Dr. Stevens chimed in. Then he sternly turned to the wife. "Listen closely. All of this can be avoided if you serve your husband what he wants. Just imagine the trouble you're putting your husband in! A good wife should stay put, keep the house tidy, and get him a whiskey and some nice juicy steak after a long day's work. Every single night. No exceptions."

"Ha! That's fucking right. You hear that? Babe. Every night," he boasted. "We can go, right?"

"Certainly. We can't legally hold you against your will. One of the nurses will hand your wife an AMA form. Have her sign and you'll be on your way. Here's your script for a steroid and throat spray you can take to any pharmacy."

"Awesome," he sneered.

On cue, I printed up the AMA form and script and headed to their gurney, only to find the husband exit the ER with his wife in tow and her medication scripts in the trash. I marched up to Dr. Stevens at his desk, fuming.

"Ornery?" he calmly noted the anger across my face.  

"'A good wife should stay put'. What the hell was that about?"

"She's been here seven times. Patients like her, you give them what they want. Not what they need to hear."

"You just gave her a death sentence! He'll kill her."

"We'll see," he shrugged, grabbing the next chart.

Weeks passed. Months passed. The wife never returned. I started to worry but the endless flood of patients each night kept me distracted. In time I forgot about her.

Then I saw her, back in the ER. But she was different this time. I didn't recognize her at first. She had an upright posture. She had blush and lipstick on. She was colorfully dressed. Not a single scratch or bruise was on her. She sat next to a gurney where an unconcious unruly man was covered in tubes and machines.

I overheard a conversation between his nurse and Dr. Stevens:

"32 year old male alcoholic found unconscious and not breathing at home by his wife. Unknown down time. CPR was initiated on the field. ROSC achieved in 30 minutes. GCS 3. Hasn't moved at all."

"Any reflexes?" Dr. Steven’s asked.

"Absent. Brain CT's crap. Ammonia level's 280. Liver is toasted. His wife is over there. Says he's been taking Tylenol for headaches."

Holy shit, it was the husband! I stared at the bloated guy on the gurney. His face puffed, his skin yellowed, and he had a rounded protruding belly. He didn't look anything like her husband except those women tattoos I remembered on his arm.

Dr. Stevens made his way to the gurney. "Ma'am, I'm Dr. Stevens. We've met before."

"I know," she shook his hand.

"There's no easy way to say this, but your husband has alcoholic hepatic encephalopathy and anoxic brain injury. We've placed him on life support to keep him alive but the damage to his brain is done. I'm sorry."

"Will he ever wake up?"

"I'm afraid not."

She tearfully shook her head. "Every dinner, I cook him steak and whiskey. He was so happy, he'd sleep it off. So I cooked more."

"Every night?"

She nodded. She would go on to say how less angry he became. He was able to sleep more. There were less arguments, less beatings.  She had more freedom to clean the house, dress herself, go shopping, handle the bills, and cook meals. All while unknowingly poisoning her husband. With Tylenol and steak and whiskey.

There was a long moment of silence between the two. Dr. Stevens patted her gently on the shoulder then walked away.

The wife later took him off life support and he died the next day. I never saw her again. Rumor has it she went through an epiphany. She sold the house. Went to college. Found a job. And married a better man.

To this day, she still cooks. Mostly dishes of lean chicken and a glass of fine wine. But steak and whiskey is her specialty, and she saves them for those special occasions.

CAFE OPERANDUS, Part 2.