10 August 2009

A Sense of Place

The sense of smell is a very powerful sensation.  A distinctive fragrance can stir up a long-forgotten memory, or put you in a place you haven't been in years.  There's a certain clean, dusty smell that always reminds me of the cottage on Wisconsin's Lake Koshkonong, which we used to rent every year when I was a kid. There's a perfume that always reminds me of a girl who I briefly dated in high school.  The girl was forgettable but the aroma was not.  We all have these triggers and associations. 
All this occurred to me last night as I hunched over the face of an intoxicated gentleman who had lost a fight with the pavement.  He was unresponsive, and I was painstakingly stitching back together the tattered pieces of his lips and forehead.   Every time he exhaled, I was subjected to an intense and pungent smell of dried blood, saliva and alcohol.  It's an acrid scent, sour, with an overlying cloying sweetness.  Very distinct and unpleasant.

And that, my friends, is the smell of the ER.

At least for me.  I will never be able to smell that in my life without being immediately transported back to this place and activity (repeated so many times over the years).  Fortunately, I am unlikely to ever experience this particular smell outside of the ER.  Later, after the ER emptied out for the night, I discussed this with a few nurses & others.  Not surprisingly, there was quite a diversity of opinion.  One nurse insisted that the smell that, for her, screamed "ER" was that of melena (bloody stool from a brisk GI bleed -- also very pungent)  It can fill the entire department when you have one GI bleeder.  You come into work, smell the melena the moment you walk in, and you just know what sort of shift it's going to be.  A tech said that the scent he thinks of as "ER" is the sweet plastic smell of freshly opened oxygen tubing.  Another nurse came up with an inventive and hysterical bit of slang that I just can't bear to repeat for, um, how shall I say it, the ammonia and fishy smell of unclean or diseased lady parts.

Ultimately (of course) we came up with a list of "Smells of the ER":
  • Alcohol, Saliva & Dried Blood
  • Fresh Plastic Tubing
  • Melena
  • Feminine Issues
  • A Freshly Incised Abscess
  • 80-proof Vomit
  • Clostridium Difficile (a GI illness producing a distinctive smelly diarrhea)
  • "Hobo Feet"
  • Coffee Grounds in a tray (used by nurses to freshen the air and cover some smells)

Surely there are more -- perhaps you can contribute some in the comments.  It's gotta be distinctive to the ER, though, or at least a medical setting.  Just poop or vomit doesn't cut it.  And, like the plastic tubing, it doesn't have to smell bad, necessarily.

So what do you think?


  1. The odor of an open head wound or an injury that has caused gray matter to leak out has always seemed surprisingly bad to me.

    Also, the ER where I used to volunteer saw a lot of homeless people and uncontrolled diabetics. I got to where I could "diagnose" gangrene as soon as I walked in the door; I just had to walk around looking at feet until I found it.

  2. Not specific to the ER, but the smell of body bags has completely ruined new shower curtains for me. It must be the same type of plastic, and it makes showering smell like dead people.

  3. Here are few, from the ER, and from the back of the ambulance:
    -The smell of "fresh" chest pain, aka Nitro-Lingual spray
    -The disposable tourniquets we use, they smell oddly like vanilla, almost pleasant
    -The smell of alcohol swabs from a recent IV or blood draw

  4. pseudomonas smells "green"

  5. I don't know why but the phrase hobo feet made me literally laugh out loud.

    In my neck of the woods (and probably everywhere), hispanics have a certain smell... and they are so concentrated around here.

  6. -Dirty bodies and floor wax.
    -The inside of the fresh face mask and plastic coat which you don in anticipation of a trauma activation.
    -I'm right there with you on the Dried blood, saliva & EtOH smell

  7. I'm not in the medical profession, so my experience is from being a "frequent flier" because of severe crohns disease. I have been in several hospitals, in several states, over the past ten years and every single one uses the exact same hand soap and moisturizer.

  8. I'm a Med Tech in Microbiology, so besides the smell of poop from processing specimens, I'm used to the smell of bugs.
    Anaerobes smell awful.
    Some say Proteus smells like german chocolate cake batter - I think they're full of it, it smells awful!
    Pseudomonas smells like either grape kool-aid or tortilla chips.
    Strep milleri smells like butterscotch.
    E. coli has a distinct, "indole" smell.
    And so on...

  9. Agree with pseudomonas. Not that it smells like "green" to me. But it does have the quintessential infection smell.

    Day old iodine that has dried on the post-op open heart patients.

    Benzene from when we used to use tape to secure ET tubes... we'd wipe the skin with benzene first to help the tape stick.

    I can think of many more.. all the creams and ointments we put on patients.

    And a freshly opened package of suction tubing. Not oxygen tubing... suction.

    Good post.

  10. Hope it was benzoin, not benzene. Benzene is a toxic solvent.

  11. But benzene does smell great!


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