People tell me that I have a scary face. My niece is 14 now, and recently told me that I gave her that face. It is neither a happy or mean face, it is just that “ you can’t shock me” face. I explained to her that my job requires me to keep a flat affect at times. People tell me things in the process of explaining why they are visiting my ER and I can not show a reaction. After many years of keeping that face on for long periods of time, it began to become a natural facial expression for me.
Let me give you an example from just three days ago. A young man came to the ER to be tested for a sexually transmitted disease. Easy enough, but upon asking simple questions about symptons, he imparted that he had just gotten out prison and had gone kind of wild in enjoying things to excess. Having already been treated a week ago at the health department, he simply could not wait that week to allow the antibiotics to do it’s job on two very nasty STD’s. He just had to indulge again and was now feeling the symptoms again. I kept that face on, I was not ready to be sympathetic; I wanted to say that it was his partner that would suffer from the excess of his needs. I was not allowed to spank him, roll my eyes or even suggest that he was screwing his sex partner in more ways than was apperent, so I wore my face.
I remember orienting a new nurse a few years ago. On her first day we spent time in triage, which is that first stop where we determine the level of the emergency of each patient, to make sure the truly emergent are seen immediately. One of the first women who came into the room began a sad story (sad because it was true.) She complained that she had the jitters and her heart rate was having episodes of palpitations. She blamed it on her ex-boyfriend who came to visit last night. She hadn’t done meth in weeks and he invited her over to his place where he had a working meth lab in his trailer. He convinced her to imbibe. When I went to take her blood pressure the track marks up her arms were obvious. I asked her, bland face intact, if she’d taken any iv drugs last night also. The interview took place over just a few minutes and then she was sent back to the ED, the orientee was amazed. She couldn’t stop talking about it for hours. And her biggest comment was on how I could hear that and keep my face from showing anything.
It’s even harder not to laugh out loud. A boy of about eight came in with his dad. He had swallowed 3 quarters and they were concerned he was choking. I asked the impertinent question of why he put them in his mouth. He answered he didn’t have any pockets on him and he was just holding them there. I took him back to a room, less than two minutes later he threw them all up. I am more often tickled by the absurdity of life than the horror and ready to laugh about it. But this bland face is what gets seen.
My friends know that I have a wicked sense of humor and for a while I wrote a weekly newsletter called My World, that told the most bizarre or oddest thing I’d seen that week. But, what do I do about this face now? My hospital wants us all to smile and be friendly. And I do when it is appropriate. It’s just not appropriate when the man tells you how he accidently sat on a plastic cup in the tub and that is why it’s stuck up his bum. Or that he cut off his penis because the mother ship would not take him with one. The CSI and ER stories are often based on real life, it just takes longer than an hour to fix what we can.
So, I find myself falling into this face. When I am concentrating or listening to other conversations, my mug is neutral. Someone tell me how to give good face and still show no reaction to the strange and bizare.
Rhianna Samuels
