There is nothing you can do for her here.

The medic reports off to me in the ER. The patient is 95 years old and was here yesterday...for back pain.

"I know there is nothing you can do for her here," she tells me. "But when the EMT's took her home after she was discharged yesterday, they helped her to the bathroom. That's where we found her this AM. She hadn't moved in 17 hours."

Her words stuck with me. My gut was telling me there was more to this story; more to this patient.

"Thanks," I reply.

"Her daughter is here and can provide you with a little more information."

Oh great. The patient is sleepy and not quite as oriented as I would have liked. And by the way she's covered in 17 hour old piss.

A frail old woman came wobbling back the construction corridors and sat in the chair across from my patient. I couldn't help but think this lady looked more like the patient than the pale, sleepy patient lying on the stretcher.

I introduced myself to her and she responded that she was in fact the patient's daughter. I stood quietly, attempting to hide the calculations in my head. Obviously, a woman in her 90's is quite capable of having a daughter who's pretty old herself.

"Her back hurts and I can't take care of her anymore," says the daughter. Understandable, I think to myself. She can barely coordinate the movements of her own legs next to her worn, wooden cane let alone care for another human being. "I don't care what you do with her, but I hope she stays overnight. She can't come home."

Within the next hour the wobbly old woman disappears from the ER, minus her mother.

My gut still tells me this isn't all about back pain. The medic gave me picture-perfect vitals in report...but I will check them hourly. I fail too often because of not following my insticts, I will learn to trust myself.

She's hypertensive and her HR is 40. A stark contrast to the medic's report.

She of course is not ordered a monitor or EKG...she is here for back pain and presumably dementia.

My gut tells me to put her on the monitor and get an EKG. I will not document it so she cannot be charged and I cannot be reprimanded later.

An ER doc is sitting at the chair next to the monitor when he sees the rhythm he jumps from his seat.

"Let me see that EKG!" he shouts.

I've done the EKG and I know the interpretation. I know that she will be transferred to the big hospital. I know that her daughter would be happy that she's not coming home tonight.

"I'm not done putting stickers on it yet," I apathetically reply.

"I don't care about stickers, I want to see it."

"I only have one more."

He huffs.

"The suspense is killing you."

"Third degree heart block! She came in for back pain and I find out she's in a complete heart block!" His arrogant smile induces tiny bits of vomit in the back of my throat. "They don't pay me enough for the work I do here. I'm a genius. Who ever would've guessed she was here for something other than back pain? Where's her daughter?"

"She ditched Mom long ago, genius."

He looked at me skeptically.

"I'm just agreeing with you."