Cultural differences in the ER

When I was young, I was raised in an almost exclusively Jewish world. My parents, who grew up in the ’30s and ’40s and were first generation immigrants whose worldview was shaped by the second world war, did not really socialize outside of their own community. While Montreal is a big city, English Montreal is a small town, and Jewish Montreal is a shtetl.As a clinical clerk doing a rotation at the Jewish General Hospital, many of the older patients would recognize me, address me as Pereleh, ask after my parents and grandparents. “Oy Pereleh, you’re a doctorshe now!” was not an infrequent greeting when I came into a room in my short white coat. This made me decide that I would NOT do my internship at the JGH! I could not establish myself as a physician, earn professional respect and take myself seriously as Pereleh! I chose to do my rotating internship at a wonderful little community hospital in Westmount, the Queen Elizabeth Hospital. It served the city of Westmount, above the tracks, and the mostly Italian and Irish and Quebecois working-class community below the tracks. When I opened my practice in St. Henri (below the tracks), I went on staff at the Queen E where I did emergency and hospitalization. I did my obstetric deliveries at the JGH because the provincial government had recently closed all the small delivery rooms in the city. In the ER at the Queen E I learned about the Sunday specials. The little old blue-haired ladies of Westmount would attend church next door to the hospital, then repair to Murray’s restaurant across the street to be refreshed with scones or sticky toffee puddings. On their way out, they would slip on a patch of ice—that I swore the city of Westmount maintained for the benefit of the orthopedic surgeons—and be brought in by ambulance. I greeted them, their faces bruised, velvet hats askew, cairngorm brooch hanging, one leg shortened and externally rotated. They would look up at me stoically, wincing in pain. “I seem to be having a little trouble walking dear,” they would say. “If you could just give me some crutches, a few aspirins and a good strong cup of tea, I will stop bothering you!” One night in the ER, a man came in. He was moaning in pain, barely coherent, had a temperature of 40°C, blood pressure of 40 and a pulse of 120. He was very tender in his right upper quadrant and his skin the bright pumpkin orange of ascending cholangitis. This was not good. My team sprang into action. I was giving directions; “Gimme two 16 gauge IVs! Run the ringers wide open! Gimme Cefoxitin, I need an ultrasound, call anesthesia, call the surgeon, where’s the effing surgeon!Once the patient was stabilized and on his way to the operating room, I went, wiping the sweat from my brow, out to the waiting room to talk to the family.“We hope he’s not bothering you too much, dear,” his wife said to me. “He’s such a complainer! I told him that he just needed to take a few aspirins and have a nice strong cup of tea and he would be OK in the morning.” I explained to her that had he not come in when he did, he might have been dead in the morning. He made a full recovery.Then the Queen Elizabeth was closed, in another brilliant move by the government. Since I already had privileges at the Jewish General Hospital, I moved there. I figured I was old enough and confident enough, that I could be Dr. Feldman rather than Pereleh. I no longer did emergency medicine since, after my third child, I could not maintain doing both ER and OB. I did wander down to the ER one day to see what was up with one of my patients. As I was talking about my patient with the ER attending at the nursing station, I witnessed a woman with long black hair, clad in a pink negligee with three ropes of pearls around her neck. Ululating and screaming in pain, she threw herself on the floor of the ER and lay there writhing. “Oh my God,” I thought. “Has she ruptured a viscus?” The ER doc I was chatting with barely glanced in her direction and continued to update me on my patient. The charge nurse raised an eyebrow and with deliberate slowness signalled to the orderly that he should help her back to bed. “What’s with her?” I asked in a shocked voice. “Constipation,” he replied“Oy Pereleh,” I thought, “You’re not in Westmount anymore!”

Cultural differences in the ER

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