The Casino Patient

The Casino Patient

A story about casinos and casino towns

This story contains vile, filthy, demeaning, and shaming verbal violence.

Don’t continue reading if you are offended by this type of language.

If you are, do not begin to read this story.

Oh, where to begin.

It was about 3:30 am on a cold Reno Friday night or early morning, depending on your viewpoint.  My partner and I were staffing the downtown Paramedic unit, and the casinos were packed.  As management intended, everyone was plastered on the “free drinks while you are playing” promotion.  This way, more of them would bet beg and probably lose big.  Casinos are the only business in the world where the customers bring their money in wheel barrels and dump it onto the floor without so much as batting a bleary eye.  Winners don’t pay for all those lights.

There is no last call in a casino town, and Reno is a casino town, or at least a part of it is. There are other parts with schools, parks, shopping centers, hospitals, and so on, but the tourists, the gamblers, don’t see those.  When a person comes to Reno, it is for the twenty-four-hours a day free drinks while gambling and the good cheap food, in that order.  I think the legal whore houses come next.

Because of that, and if you let it, Reno will possess you financially, physically, and emotionally.  Before I escaped that insanity, I let it do just that to me.  So did the woman who would be our patient in the next call we ran, as did her “companion.”

I mention the personal note to show that I understand how damaging a casino town can be.  I let Reno capture me.  As a result, I’m an expert, or at least I used to be.  One day, somehow, I realized what was happening, quit my job, moved out of Reno, and entered a two-year recovery program in a different city and state.  By the grace of God and many good people who cared, I’m still in that city, clean and sober with a successful and rewarding life, and I can write this story.  But, back to The Casino Patient.

The call came in as an agitated woman, and we were dispatched CODE THREE, lights and sirens, for this non-emergency.  There was an unofficial agreement between the casino management and the city of Reno.  No matter the event at a casino, whether a toothache or a heart attack, when they called for an ambulance, the dispatch was always  CODE THREE, lights and siren.  The casinos wanted this and always got what they wanted,  Even if the unjustified risk to the public and misuse of emergency authority were illegal and completely unprofessional.

However, because the casinos wanted it that way, everyone overlooked it.  They expected it, just as they expected us to throw the patient on the gurney and run to the ambulance.  No exam, nothing.  Just end the situation immediately and do everything in the ambulance, even if they weren't breathing.  The casinos wanted this, and they always got what they wanted.  

Also, it was understood that management would be very grateful when the Paramedics “extricated” or immediately removed any particular disturbance.  A casino has access to many perks.  It was a good thing to have casino management grateful.

As we walked in, The Casino Patient was lying on the red carpet on the floor in front of a bank of nickel slot machines and screaming, supposedly because of pain.  There was also a skinny man nearby yelling in his cracking, mousy voice, “you cunt!!  I told you not to do it!!  I told you not to do it!!  I told you!!  Now your pussy is rotting!!   “I told you!!  I told you!!”  Over and over.

In response, the woman, in her full booming voice, was yelling back, “shut up, you pencil dick!!  You pencil dick!!  Shut up!!  You pencil dick!!  Over and over.  We had to deal with this fast.

I walked up to her or tried to and was hit by the smell.  It was the smell of a pig farm.  A big pig farm and it was incredibly overpowering.  I had to step back to get away from it.  As I did, the police officers chuckled.  What else could they do?  What else could any of us do?  In the eighties, there were no tasers or sprays.  The police could arrest them, but they and the casinos didn’t want that.  Arresting customers wasn’t good, so everyone waited for the Paramedics.  

After stepping back, I squatted in front of her about three feet away and said, “Hi, I’m your Paramedic.  Tell me what’s happening to you.”  In response, she spits in my face.  

“You shithead,” she yelled, “it’s my f**king pussy!!  My pussy is rotting!!”  Then, as I wiped the spit from under my eye, the skinny guy jumped in.  “Cunt, I told you not to do it.  I told you!!” still in his cracking, mousy voice.  “You’re just a shit-hole cunt!!”

Then I jumped in, trying to stop the yelling, “what did you tell her?” I asked the skinny guy, terrified of what was to come.  “I told her not to put my teeth in there again.  She puts my teeth in her pussy.  I can never find them.  She always does it, and her pussy is bleeding because it is infected.  My teeth get infected!”

Oh my God, I thought.  Dammit.  She’s bleeding.  I had to examine her before we could move her.  And I was terrified, again, of what was to come.  The casino people went nuclear.  “Get her out of here,” they told me in outraged voices.  “You must get her out of here.” 

I replied, “I must know how much she is bleeding before we can move her.  I could make it worse if I don’t know how much she has already bled and how fast she was bleeding.  We’ll be out of here in two minutes.”

This lady and her “companion” were regulars in the casinos throughout Reno.  Almost everyone who knew them knew them well.  But it was this particular casino they visited most.  They came in regularly, day or night, and played the nickel machines for the free cocktails.  They would make those nickels last for hours.

There was a reason they were known almost everywhere, other than for playing only the nickel slots and their nickel-stained fingers and hands.  Those fingers and hands were striking in their appearance and could not be missed.  They were stained deeply from shoving in those nickels; half of the index finger and thumb on the right hand were charcoal black.  All the other fingers and the palm were a dark gray.

But, as I said, that wasn’t the reason they were well known.  Mainly they were known for their public displays of extreme drama.  In all of Reno, these two were the best; no contest, hands down, don’t even try.  They knew how to put on a show, and the casinos hated them.  Actually, they feared them.  I saw them in a casino on one of my days off.  Imagine my surprise after arriving at the scene of this call and walking up and seeing who it was.  I never did understand why the casinos allowed them to return. 

In addition to the extreme drama, these two were not average-looking people.  I was certain the woman weighed more than five hundred pounds and was the very definition of a “sweat hog.”  Tonight, she smelled and looked like she had not changed her clothes or had a bath in a month or two.  Really, a month or two or more.   It had to have taken months for her to accumulate those stains on her fingers and the filth on her body and clothing.

Her “companion” was a skinny man, about five-foot-four, and whether or not he was soiled with old urine and feces or covered in vomit, he could not have weighed more than a hundred pounds.  He looked and smelled as bad as she, and the two of them together were almost toxic.  An odiferous cloud engulfed them and poisoned the air wherever they went.  

The vomit, urine, and fecal smells were coming from their clothing.  I became able to recognize and differentiate these odors early on during my time in Reno.  Unfortunately, I was exposed to them all too often.

The smells of old alcohol and nicotine were coming from their skin.  They were actually sweating out these built-up substances.  That means they probably hadn’t been sober for______. You fill in the blank.

We ambulance people had two rather unkind humor “tools” some of us used to deal with these patients.  The first was the “GOMER” award.  It was the honorary title of the person with the widest variety of critters on his body.  It was an acronym for “Grand Old Man of the Emergency Room.”

The second “tool” was a story about others similar to these two.  We saw too many of them too often.  Here is how it went;

A Paramedic said to his patient,  “Hey, dude, did you take a dump in your pants?  Something smells really bad.”

“Hell no, it wasn’t me,” the ‘dude’ responded.

The Paramedic countered, “But I can see it on your pants!  It’s right there.”

“Oh,” the ‘dude’ replied, “I thought you meant today.”

These two were yelling at each other so loudly people outside the casino on Virginia Street could hear them through the always-open glass front doors.  

Inside, in the back of the casino, people there had stopped gambling and were also listening.  Of course, this was just what they wanted.  An audience.  The crowd around them was already big and was rapidly increasing, and the casinos didn’t like crowds.

When people were distracted and standing around, either in a crowd or not, they were not gambling, and when people were not gambling, the casinos were not making any money.  That’s why there aren’t any windows or clocks in a casino.  Those things also distracted people by reminding them whether or not it was day or night and how long they had been gambling.

These distractions thwarted the casino operators.  They knew how much money was coming in from the slots every minute at any particular time, day or night.  The slots recorded how many times the arm was pulled and the amounts of the bets.  Those stats were matched with the time of day and the time each player played, and all was revealed.  Because they knew how much they were making, they also knew how much they weren’t making when gambling stopped.

Again, this lady, who was still on the red carpet floor and screaming, was morbidly obese, so obese her fat was fat, and she had one of those aprons of fat hanging down in the front.  Her’s was so large it was covering her knees, and I had to lift it to visualize the affected area.  The mass of adipose tissue itself must have weighed a hundred pounds.

In those days, we didn’t use gloves, and her skin was so oily and grimy that it kept slipping from my grasp.  Finally, I used a sheet to create some friction and lifted it.  When I did, out fell dozens and dozens of live maggots.  Dozens of them, all over the red carpet.  I was in trouble.

The crowd gasped loudly in unison, and one of them immediately puked, almost hitting the woman on the red carpeted floor and my feet.  And you know what happens then, right?

When one person in a crowd pukes, others usually follow, and that’s what happened on this occasion.  Two more followed in succession, one right after the other.  One was on the right side of the crowd, the other was on the left, and there were only about fifteen seconds between them.

The three of them went Puke - pause.  Puke - pause.  Puke.  I could see the heads in the crowd turn in unison toward each of the pukers each time it happened.  It looked exactly like a crowd at a tennis match.  I couldn’t believe what I was seeing.  It would have been almost comical if it hadn’t smelled so foul.  Actually, it was comical because it also looked like a skit out of a “Three Stooges” movie.  It was hard not to laugh out loud.  In fact, one of the police officers did.

I was done.  I covered The Casino Patient with the sheet I used to lift her apron of belly fat and, with the help of six Firefighters, rolled her onto the gurney.  Then, with three of them to a side and maggots falling everywhere, they lifted her from the floor.  As they pushed the gurney toward the ever-open doors on Virginia Street, leaving the maggots and vomit-covered red carpet behind, the maggots continued to fall from the gurney.  The carpet was such a mess; it didn’t even matter that two more people puked as we were rolling her out.  I could hear them through those open doors.  Outside, I asked the skinny guy why she hid his teeth inside herself.

He replied, “she won’t let me eat.  She says I must be on a diet.  She won’t feed me at home or let me eat at the casinos.”

“Well,” I said, “it looks like the diet is working.”

He went ballistic.  “You cunt” he yelled at me in that same cracking mousy voice.  Evidently, he had a small vocabulary along with his pencil dick.  “I’m hungry all the time!  She’s killing me!”  

“Why don’t you leave her?” I asked.

In his mousy cracking voice, this time whining in self-pity, he said, “I can’t leave her.  I’m stuck.  She has the money.  And besides, she’s my mother.  Would you leave your mother alone in a casino?”

I was stunned into silence.  Just.  Simply.  Stunned.  Then, without saying a word, I turned, walked to the ambulance, got in the driver’s seat, and drove to the ER leaving the skinny guy at the casino and the mercy of Reno.  Mom needed a surgeon. 

I assigned my partner to ride with her and the maggots in the back.  Paramedic’s prerogative.  It was about 4:30 am, and I knew I would be in the back soon enough with a real emergency.

The kicker to all this was, without a doubt, sooner or later, there would be another bizarre call similar to this one or even more extreme.  It probably won’t happen on this shift, but sooner or later, it will come.  They always did.  As we pulled away from this one, the casino played on with its front doors wide open and all its maggots, so to speak.

Henry Lansing Woodward

Paramedic