Heloooo, nurse!
Don't let the kitten sweatshirt fool you, Granny's seen a thing or two....
Back in residency I did a rotation at the Veterans Administration (VA), and I’ve never been as genially or frequently sexually harassed as I was there, by the just-hanging-on World War II vets and the slightly younger Korean War ones. I can’t tell if they were pretending to mistake me for the broads and dames of their youth, when they said things like “I know I’m here for a sore throat, but I expected a more thorough exam,” while looking down at their lap and then waggling an eyebrow at me. Or: “Helloooo, nurse!” while swatting me on the behind.
I remember one man who, after I’d gamely removed his hand from my derriere and reminded him that no, I’m not his nurse, I’m his doctor, looked momentarily contrite and said, “Apologies, they’re building docs different these days,” fully convinced the error was in misidentifying the job title of the handful of flesh he’d just grabbed. I think positively about my patients,except when they call me “nurse.” I didn’t suffer through so many years of school for that! Besides, it turns out that I’m terrible at starting IVs, getting pumps to stop beeping, and other vital nursing skills. My capabilities don’t merit the title.1
Most of my patients’ groping was halfhearted, perfunctory really, as if they weren’t in the game anymore but still wanted to honor it. They’d hide, with greater or lesser levels of success, behind declining cognitive function. Some had their faculties and were feigning to be dottier than they were. The wives were funny. I remember one who walked in to hear her husband announcing, “Bet you’ve never seen a pair like these before!2” as he revealed his enormously edematous scrotum as if it were a great prize. She said, “Harold, this nice young lady doesn’t want to see your giant testicles.” They shared what can only be described as a private, lascivious look—I might not have wanted to see them, but she clearly took the occasional look (and good for them)— and she gave a throaty laugh.
I felt like I’d walked in on something, even though they weren’t trying to hide. She flicked the blanket back over his giant balls and shook her head with amusement. Her hair, grey and styled in an old-lady perm, along with her frumpy grandmotherly sweatshirt with a painting of frolicking kittens on the chest, seemed incongruous with the exchange.3 Don’t let the sweet-old-lady act fool you. I’ve seen the statistics on STI transmission in old folks’ homes, which lead me to a few conclusions: 1. We need to get STI vaccines through the FDA quagmire and in arms ASAP, 2. Cialis has changed things, and 3. Getting old looks pretty bad from the outside, but I guess there are some compensations.
Then there was Leroy, a 99-year-old man who claimed blindness as the reason he’d start groping the air the moment I’d walk into the room and wouldn’t stop until I got close enough to “see,” as he put it.
“You’re looking too low, Leroy” I’d say to him; he was not, as it turned out, legally blind. “My face is up here.” I’d grab his glasses from the bedside table and slide them over his nose.
“I can see! It’s a miracle!” he’d laugh, entertained by the same exchange we had twice a day when I’d come by to check to make sure his biliary drains were unclogged. Looking me in the eye to confirm the placement of my face, he’d say about the glasses and my face, “Well, look at that, you’re right.”
At the time, I thought the VA rotation was mostly patients trying my patience. But dodging wandering hands while simultaneously performing a physical exam turned out to be a key skill in my first job as an attending in a NYC level-one trauma center, especially when the wandering hands were fists on a violent patient who was trying to knock me in the face while I ducked and weaved to get close enough to restrain and sedate him. Skills aren’t always 1:1. Just like practicing scales readies a pianist for Rachmonninoff, soft medical skills can turn out to save a life, even if the life I’m saving is my own.
Not all patient experiences improved my future patient-care skills. Gary kept his hands to himself but, whenever any woman from the medical team walked into his room, started to loudly opine on her resemblance to one of his (many) ex-girlfriends, whose merits he’d recount in great and occasionally graphic detail. Have you ever heard that ‘90s classic, “Mambo No. 5?” Gary was like that: “A little bit of Monica in my life / A little bit of Erica by my side / A little bit of Rita's all I need / A little bit of Tina's what I see.” From Gary I learned that sometimes you have to stop listening to what a patient is saying. I wouldn’t recommend utilizing that skill too frequently—it’s the default for too many docs—although sometimes it’s necessary to preserve the health of the patient. In Gary’s case, it kept me from clamping my hand over his mouth and accidentally suffocating him.
I thought of guys like Harold, Leroy, and Gary when “Mildred” came into the ER. She was in her late 90s and quiet: her friend, maybe her “special” friend, did most of the talking, even though I kept speaking to Mildred. Someone talking over the patient drives me crazy, unless the patient is unable to speak or has advanced dementia, but even then I like to give them the opportunity to answer, however incomprehensibly, for themselves first. Docs who treat an elderly person like they’re a deaf, demented prop, and immediately address someone younger in the room, irk me. Even if the patient is deaf and demented, I like to assume they can tell when you’ve at least attempted to acknowledge their personhood. It’s a courtesy that seems as necessary to me as the compliments about my figure seemed to the enthusiastic VA patients.
But Mildred stayed quiet. She only smiled happily at me, the smile of someone who might actually be too far gone to understand the seriousness of her symptoms. Finally, after performing a physical exam and hearing the crackling sounds coming from the base of her right lung, I told Mildred that I’d need to order some blood work and get a picture of her chest.
“Well, dear,” she finally spoke, winking, “I usually charge for that.”
When I’m teaching medical students and residents, I find it baffling that so many are actually conned by the “sweet old lady” trope I mentioned earlier. The look of shock and horror when I ask if they considered testing Nana for syphilis! I remind them their grandparents were once young. Whatever they’ve done, or want to do, or are attempting to do, or are trying to talk their significant other(s) into doing—chances are their grandparents once did, or wanted to do, or attempted to do, or tried to talk their significant others into doing, too.
If anything, the older the person, the more years they’ve had to really lean into their perversions inclinations. It’s made worse, not better, by the free pass that the expectation of mild dementia provides. They know what they can, and do, get away with. The same kind of comments (or in the case of the VA patient, bottom smacks) from someone 20 years younger would result in being escorted off the hospital premises.
My soft spot is for the ladies who flip the dirty old man script and catcall their cute male nurses, or the one who shamelessly grabbed me on the boobs and said, “I remember when I had ones like these,” and who wistfully regale me with smutty stories from their younger years. By “younger years,” I mean their 70s, when they went through, as one woman put it, “what my granddaughter would call my ‘ho era.’” I find it aspirational.4 Aging can be scary, but it’s nice to have something to look forward to. Especially when that something is being the dirty old grandma on the block regaling my grandchildren and other youths with stories of Burning Man 2001-2022.
Emergency medicine teaches you things about humanity that you won’t even learn from Chekhov or Shakespeare.5 Then again, you might learn the same lessons in a bawdy story by Chaucer: People don’t necessarily become less who they are with age, they’re just sometimes better able to get away with it.
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I’ve been lucky to work with great nurses, many of whom seem capable of drawing blood from a stone and can cannulate veins that must only be visible in the UV spectrum. I don’t pretend to know what kind of sorcery they practice, but I’m impressed.
In fact, I had seen a pair—many pairs—that were similar, if slightly smaller. More than half of my patients were retaining fluid, and the scrotum, thanks to elasticity and gravity, can inflate to an impressive, uncomfortable-seeming degree.
The stories of vigorous masturbators will have to wait for another time, but I’m leaving this note to myself so I either make sure to write it, or get harassed by readers into writing it, which is in keeping with theme of today’s stories. Emergency medicine generates a shockingly large number of genitalia-based stories—fewer than OG-GYN or urology, but a lot.
If I make it remotely close to Mildred’s age, I know how I’m going to behave. Also, Mildred did allow me to get an x-ray of her chest without charging me and I’m happy to report that her lab tests returned positive for a viral illness, negative for pneumonia, and she was discharged home. As she told me, “I’m not staying overnight. If I’m going to spend that much money on a bed that isn’t my own, I’m going to the Four Seasons in Hawaii.”
But here you are on Substack, with the modern Chekhovs and Shakespeares and Emergency Physicians.
Haaaa Brilliant, Bess. Thanks for sharing the stories. Thanks for being you and treating patients like humans, not stereotypes.