Love has won: strangers, lovers, and the doctors who bet on them in a NYC ER.

The night is hot. The city is libidinous. My patients meet under the romantic fluorescent lights of the ER. Is it kismet? Can that be treated with antibiotics? Is kismet a billable diagnosis?

If you find this piece worthwhile, consider the Go Fund Me that’s funding Jake’s ongoing cancer care. All characters in this story are fictional, any resemblance to real people is coincidental.

It’s 2:30 am on a Saturday night in the last month of my intern year and I’m going to win the $15 Blotto Lotto—I just know it, though I don’t expect the mechanism of action to be patients who go from strangers to lovers in the emergency room, which is not notable for its romantic ambiance. I need this Blotto Lotto win, though, and who doesn’t love love finding a way?¹

This is my fourth overnight shift in a string of five: There are blood stains on the top of my fun, new, orange and white polka-dot sneakers, courtesy of the motor vehicle rollover I cared for last night in the trauma bay (the dominance of autos as a mode of transit is insane). I’d thrown disposable shoe covers and a gown on when the alert came over the EMS phone, but the covers provided a limited practical barrier as blood spurted out of an unclamped chest tube, draining my patient’s hemothorax all over my new kicks. Soaking them for an hour in hydrogen peroxide—a doctor pro tip for blood removal—keeps me from looking like I’ve just slipped in the blood bank, or become a vampire with sloppy eating habits,² but now they’re stained and ratty looking. My hair is ratty, too. I’ve collected it into a low ponytail, but the weather makes my curls shrink and spring free around my face into the sort of coiffure that’s always coy and flattering in movies, but on me it looks more like I’ve been roughed up in the back alley and then dispatched to see more patients. Which is an apt description of what practicing emergency medicine in New York City is like.

The pressure of transitioning from a novice to a journeyman ER doc is catching up with me. There’re only 13 shifts between me and the start of my second year, the year when we learn to be fast. If the waiting room is overflowing, my job will be to empty it like that half-drunk beer in college. Interns learn how not to kill people, third years learn to supervise, but the second years work. In addition, second years are also not supposed to kill anyone, not even the complainers. With so many patients at a time, all needing help, attention is like loose change in a beggar’s cup—inadequate. There’s always something to miss, even if you ask the right questions, even if you look real hard. You’ll never be able to look hard enough. My attending physicians have described the practice of emergency medicine as “wearing clown shows in a minefield.” They also say it’s better to be lucky than good.

If I won’t have the time to look as closely as I’d like, I can at least look frequently. Tonight, I’m practicing streamlining my workflow so that when I go to see a new patient, I also pass by and “eyeball” the ones I’ve seen before. Green pod makes this easy—it's a large rectangular room with curtains forming smaller patient rooms around the perimeter. The doctor’s charting station—the doc box—is in the center. Only the two corridor rooms connecting Green pod to the neighboring Blue pod are unmonitored and out of sight, around a sharp corner from the doc box, so, to decrease the risk of missing a sick patient decompensating, I reserve those rooms for patients who appear stable, like the patients who need to sleep off a little too much partying.

The Blotto Lotto started as a simple betting pool: Whichever resident rouses all of their non-critical Saturday night intox patients first (any intoxicant counts for the game) and gets them discharged and happily out the door before the start of day shift wins the night’s pool. It’s $5 per resident, per Saturday shift they choose to play. Patients with discharge papers in hand, but who refuse to get out of bed, or yell in the hallway, or get caught trying to drink from the hand sanitizer dispenser, don’t count. Due to the game’s popularity, we’ve instituted a bracket system to determine the overall champion. I’m one more win away from the semi-finals.

Marco, the senior resident I’m working with, is a fierce competitor: he graduates in a month, so he has two extra years of tricks, although he made the error of teaching some to me before the game began. Another consequence of him graduating in a month is that if he fights dirty, there aren’t long-term social consequences. Marco doesn’t care about the love of his fellows. Marco loves only two things: surfing and leaving work on time.³In Corridor A, separated by a curtain, lie my two, sleeping Blotto Lotto patients. The first, a twenty-something dropped off by his buddies, accidentally ate an entire brownie edible—100mg—and decided that his friends were either raccoons in human clothes, or maybe it was humans in raccoon clothes, but I can’t ask him to clarify, because 2mg of Ativan solves the frantic, paranoid anxiety problem. The second is a college student who drunkenly tripped on her stiletto platform heels in front of the ER entrance, had a negative ankle X-ray, refused to remove her shoes, and asked if she could pay with her New School ID. She’s asleep too. I’d also like to be asleep (I hadn’t yet figured out that modafinil and other stimulants are how my co-residents survived shift work).

The rest of the Green pod is filled with the usual milieu: belly pain, a chronic, unchanged years-long cough who expects to be magically cured overnight on a weekend, and a broken bone on a tourist who decided to jump up and down on a wobbly basement grate to prove to his buddies that they shouldn’t be afraid of walking over loose grates. His theory was disproven via experiment.

I’ve just done another round on all my patients, including the two sleeping beauties in Corridor A, and join Marco to finish charts in the doc box. The back door to the ambulance bay is open, letting in fumes from the idling ambulances, mixed with the thick NYC summertime humidity. We have a view through the ambulance bay and onto the street. Behind the thicket of ambulances, we spy East Village revelers cutting through Stuyvesant Square Park and down 16^th street to the bars on 1^st avenue, or to the KMP next door for a chopped cheese sandwich and kimchi. The best late-night food in the world, whether you’re drunk, or caring for someone who is. We make a few side bets on which revelers we think will become patients.  

There’s an eroticism to the city’s summer nights that makes weekend shifts restless. Maybe it’s the sweat, and the bodies pressed against each other in the crowded bars. Even the slightly rank, overripe odor from the trash piles up on sidewalks adds to the effect. Perfumers purposefully add a subtle hint of indole to their scents, which is also the molecule primarily responsible for the scent of feces and decomposition.⁴ In the ER, there’s nothing appealing or subtle about trash/feces/decomposition smell, but maybe there’s something to the faint scent of hot rot that makes people libidinous.

Marco leaves me at the desk to step outside and watch the parade for a few minutes, then goes to do his own rounds. He comes back from around the corner leading to Corridor A. 

“Serino, have you checked on your patients?”

“You saw me do it, I was just back there.” We’re judged harshly on perception in residency. Whether I saw my patients or not doesn’t matter if my senior resident reports that he doesn’t think I saw my patients. Well, it matters to the patient, but not to our program director.

“I’d look again.”

“What’s wrong?”

Marco’s too calm for someone to be expeditiously dying. He makes an oh, I don’t know, just a thought, you do you face and shrugs.

In Corridor A, the curtains are closed, though there’s no beeping, screaming or bodily fluids pooling. The prodigious snoring coming from both my patients has stopped. It’s quiet. Too quiet? Like when a house filled with toddlers goes ominously silent.

“It’s Dr. Serino,” I announce, pulling back the curtain on my drunk woman. The bed’s empty. Her purse, however, is still there. I announce myself again and open the other curtain. Edible guy’s still in his bed. Drunk girl, however, is also in his bed. Which ICD-10 code covers this situation? How will this affect my Press-Ganey scores? I think positively? Many people sadly don’t get what they want from the ER. She’s straddling his upper thighs, her spiked heels pushing dangerously into her backside. The top half of her dress is down around her waist. Her eyes are glassy and while she seems to look right through me, both of her pierced nipples are pointing directly at me, and at eye level.

“Hey!” I say. I hear a laugh come from the doc box.

“We’re not doing anything!” Weed guy says, furiously stuffing his still-soft penis back into his pants. I did pretty well on my urology rotation, and from the look of it, the mind was willing but the body unable.

“You’re trying,” I say. I point at the woman. “Off!”

I’ve hosed down two stuck dogs before, but I try not to extend that level of puritanism to people just trying to have a good time. Unless it’s in my ER.

“Off!” I repeat.

“Rude,” she says and slides off his lap, landing surprisingly nimbly on the ground. She teeters like a foal. She suddenly looks like she’s about to either throw up or cry.

 “I need you to go back to your room.”

She makes a break for it.

I chase. She’s surprisingly quick. How is she so fast in these shoes? I’m only two paces behind and catch up in time to see her rounding the corner at the same time as the medical assistant, who is holding a tray of patient snacks. Startled, he holds onto the tray, but drops half the muffins as she pushes past.

“Wait,” I say, and she freezes again, this time in the middle of Green pod. I wonder if I could just shine a bright headlight at her to keep her in one spot. 

“Your clothes,” I say, pointing to her chest.

She fingers the fabric, considering, then pulls off her dress and underpants in one quick motion. She walks towards the main entrance.

Marco, instead of helping me, is laughing hysterically. Is this a teaching moment for him? The corridor A nurse, David, a sensitive bear of a man with a very conservative religious background, approaches the drunk woman to try and redirect her, but then looks at his hands, and at her, and decides against wrestling the naked lady. He grabs a blanket from the blanket warmer and unfurls it, holding it lengthwise and walking towards her like he’s trying to snare a wild animal.

She makes for the ambulance bay. I cut her off and she stutters just as David walks up behind her and throws the blanket onto her from the back. I wonder if she’s technically free to leave, against medical advice (AMA), since she can walk in a straight line; it’s a free country. But she’s also trying to elope naked, so I doubt the totality of her sobriety. She must like the blanket’s warmth, because she wraps it tightly around herself. David tosses me another and I wrap it around her waist, both using it as a cover up and to discourage her from fleeing.[6] Marco claps silently and nods with approval as I guide her back to bed. Is this education? There aren’t beds available in the main pod to transfer her to, so I send the one-to-one tech usually reserved for monitoring suicidal patients to the A corridor to chaperone.

When I check on my two unlikely paramours a half hour before shift end, they’re both rousable (though, thankfully, not aroused). Both answer basic questions, walk in a straight line, and pass a field sobriety test. I send nurse David back with discharge papers. I watch the clock, ready to hustle them out because they don’t need the ER, and I need them gone before shift change—if they leave in the next two minutes, I’ll be victorious, since Marco’s last Blotto Lotto patient is still struggling to put on his pants.

When they emerge, they emerge together. She’s significantly shorter than I remember and I realize that the heels she wouldn’t take off are now in her hand, her bare feet on the disgusting ER floor. She cheerfully accepts a pair of grippy socks I offer. All those years in med school have prepared me for this situation.[7]  

She scrawls something onto weed guy’s discharge papers—her phone number. He does the same. “You can exit that way,” I say, and they do. He takes her hand as they walk out into the city together, the smell of stale alcohol, of promise and possibility, in the air.  

Marco comes up beside me.

“Does this mean I’ve won?” I ask.

“Love has won, Lauren” he says, wiping a fake tear away from his eye. “Love has won.”

If you’ve gotten this far, consider the Go Fund Me that’s funding my husband Jake’s ongoing cancer treatment.

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1. In the famous Jurassic Park scene, the mathematician played by Jeff Goldblum claims that “life, uh, finds a way.” In the book, he says: “Life breaks free. Life expands to new territories. Painfully, perhaps even dangerously. But life finds a way.” A couple years ago, Jake and I exhausted ourselves hiking in Flagstaff, and we watched Jurassic Park that night. It didn’t hold up as well as we’d hoped. I suspect it’s ideally watched with a six- or seven-year old.

2. Though I am that, too. Kidding, kidding! If I turned into a vampire, though, I’d be a hell of a nocturnist, and nocturnists make more money in many hospitals.

3. Men who love something like surfing more than they appear to love women feel like they are against the natural order of things.

4. In American Hustle, the Jennifer Lawrence character claims: “It’s like, perfume, but there’s also something, rotten. And I know that sounds crazy, but I can’t get enough of it. Smell it, it’s true! Historically, the best perfumes in the world, they’re all laced with something nasty and foul!”

6 A patient who can’t walk in a straight line or pass a sobriety test could be considered an unsafe discharge. I’e never seen any rules on the subject, but letting someone run out into NYC naked might also count as an unsafe discharge, even though it wouldn’t be the first time I’d see that on the street. We’re rarely supposed to physically restrain the patients, however. Rules conflict!

7 When people ask me to tell them an ER story, they usually respond in one of three ways: “Gross!”, “How sad!”, or “You had to go to medical school to do this job? You sure?”