...however, I do tend to get chatty with patients. I crack jokes when it's not horribly inappropriate. I acknowledge the absurdity of situations. I play with kids. Last night, I asked a 14-month old child what 15 times 6 is. When he told me "baabwoooo," I agreed he was probably right, and thanked him. Then I wrote down "90." This all happened after I'd plugged my stethoscope into my ears, listened to the frame of his stroller, listened to the top of his head, listened to my arm, and then finally listened to his little heart. 30 seconds earlier I had been approaching the kiddo's personal space with a foreign object of nefarious design, and now we were burbling about math. The parents appreciated it too... or at least put up with it.
People need to understand what you're doing, and why you're doing it. If they're drugged to the gills, in severe pain, can't breathe well, really anxious, or 14 months old, this may not be possible. Still, it's better for them and for you if they know you're not a sadistic equipment-weilding boogeyman. At the very least, they should have some indication that you're someplace in the neighborhood of okay, and at the very very least, they should be distracted and confused, because the process of trying to decipher "what the--" can be enough to lessen pain and fear, for a moment.
I also had occasion to meet a grownup or two on last night's shift (see below). I mentioned that the patient in that story served in WWII, and this information came out during small talk while he was on a gurney having a heart attack. This may seem odd, but trust me, this is the thing that "ER" the show lacks most egregiously, in my opinion. There is some sparkling conversation and dramatic opposition that happens in those rooms. The bongo drums are a cheap way to inject tension that could be there tenfold, if the situation were presented well. It's mind-bending and sublime, the mingling of the mundane and the literally life-or-death. I'd be riveted by a scene where a patient chats about some random quotidian thing while people, machines, and drugs that come out to several thousand dollars in hourly costs did their work.
But here's the thing about why I like to chat so much: talking to people is a great way for me (and the half-dozen people in the room with ten times the education I have) to assess their airway, their mental status, and their pain level. Also it's friendly, and a nice thing to do. Not least of all, if I were the patient I'd be reassured by the idea that the painful scary crap that's going on with me is also, on some level, just a normal day at the office. If something that is rocking my world in a bad way is no big deal to some group of people somewhere, then I want to be with those people at that moment. I never want to be an "interesting" case, much less a stressful one, for people whose job is to save lives.
If I'm ever lying there, having my clothes cut off and my circulatory system temporarily reconfigured with the help of needles and plastic tubing, I want to hear some chatter from the team. I don't want to hear clenched jaws and see beads of sweat on foreheads. I don't want terse commands and silence puncuated by beeps. I want to hear about restaurants and car payments and kids' baseball. I want to hear people giving each other crap. If a vein should blow and a nurse says whoops, that IV needs to be re-done, I want somebody like me dabbing blood off an arm like it's not a big deal, because it's really not. It's all good. It's under control.