Why?

“Why?”

That’s a pretty common question, isn’t it? Our children ask us that a lot, or we ask it of someone who might know the answer to a difficult problem. And sometimes we just want to know… well, we want to know “why.”

Sometimes it’s an appropriate question. And sometimes it just needs to be left alone. “Don’t ask why” can be the path of wisdom. I know this is true in the emergency department, and maybe in some doctors’ offices. It’s a lesson that needs to be learned early on by young physicians, and it’s something that we, the “older and more mature” ER docs try to teach them. A lot of times though, we have to be reminded ourselves.

Usually the lesson begins when we overhear nurses or interns asking: “Why did that guy come into the ER at 3 in the morning with a skin rash that he’s had for six years?”

Or, “Why does that lady come here every other night with the same problem, week after week?”

Or, “Who in their right mind would bring their kids out in the middle of the might, in the middle of an ice storm, because they have pinworms? Why?”

And then they worry about these things, and they begin to fume. The problem is they are trying to understand the reasons people do the things they do. Most of the time, that’s something we’ll never be able to figure out. But the effort quickly leads to frustration and eventually to anger, and even resentment, which is never a good thing. So it’s been our job as seasoned veterans to share our “wisdom” with them, and to draw on our years of experience.

“Don’t worry about that,” we tell them. “Hey, what difference does it really make? Just see them and move on to the next patient. You’re never going to understand these things.”

But sometimes it’s not easy to just move on to the next patient. Let me give you a couple of examples.

8:35 p.m.

The triage nurse had just taken a 20 year old man to Room 7, one of our general medical beds. She handed me his chart, shook her head, and walked back out to the triage area.

I glanced at the record and the chief complaint. “Smoking cocaine. Feels funny.”

Hmm. We see a fair number of patients with problems related to substance abuse, cocaine being one of the most frequent offenders. It’s a dangerous drug. Whether inhaled, injected, or smoked, it can cause some serious problems. There are specific complications that we need to look for: cardiac involvement, strokes, and seizures. Fortunately, this young man seemed to be stable as he had walked by, and his complaints were not necessarily of a serious nature. His vital signs were stable, and his examination turned out to be completely normal.

“Now tell me exactly what’s the problem tonight?” I asked him.

“Well Doc,” he began, leaning back on the stretcher and folding his hands behind his head. “I was smokin’ some dope with my friends this evenin’, and I just got real dizzy. Real, uh, sorta light-headed, I guess you’d say. You know what I mean?”

“You didn’t have a headache, or any chest pain?” I persisted. “You didn’t pass out?”

“No, none of that. I just started feelin’ funny, and I got scared.”

“Have you ever smoked dope before?” I questioned him, beginning to wonder exactly why he was here.

“Oh sure, all the time,” he answered.

“And you’ve never felt funny before?”

“Oh, man yeah,” he said, laughing. “After a few puffs, you get real dizzy, ya know. Real…spaced, ya know. And I thought I’d just come and get checked out. You can’t be too careful.”

It was a struggle, but I remained silent.

11:30 a.m.

Jane Doe was in one of our ob-gyn rooms. She had come to the ER with complaints of abdominal pain.

I walked into her room, closed the door behind me, and sat down on a stool.

“Ms. Doe,” I began. “Tell me about your stomach pain.”

“Well doctor, it started about four days ago, and I called my gynecologist, Dr. Smith. And I made an appointment to go see him.”

“And have you had a chance to do that?” I asked.

“Well, not exactly. I had an appointment this morning and went to his office to be checked, but I never saw him,” she answered.

“And why was that?” I asked, curious. “Some kind of emergency?”

“No, nothing like that. They took me back right away and put me in a room,” she explained. “Then one of the nurses came back and explained that Dr. Smith had to be in another office that day, and that I would need to see one of the other doctors.”

She rearranged the sheet that covered her, patting it gently, and then continued.

“Well, you know I’ve never seen any of the other doctors in that office, just Dr. Smith, and I didn’t want some stranger examining me. I guess I’m funny that way. So I got up and got dressed, and told them I was going to the emergency room. So here I am.”

Say what? Now maybe that’s a better question.