Tonight I’m working third shift in the emergency department.  It seems appropriate to take this time, yet again, to update everyone on my experiences and observations.  So, it’s 1:18 am.  I have only seen 11 patients since 11 pm.  Standard stuff.  But, as always, the night is rich with wisdom to be mined and cast abroad across the blogosphere.

Patient:  ‘My child has a fever.  The pediatrician said for me to come in and have someone check his ears and throat.’  I almost called the pediatrician back just to say, ‘hey, his ears and throat are fine.’  Which, of course, they were.  It was a FEVER!

Patient:  ‘I jutht tookk fooorteeen ambeean.’  Translation:  I just took fourteen Ambien.’  Why?  ‘I hadd surggerrree and wantteddd somethinngggforrpainn.’  Pill count comfirms fourteen missing Ambien, possibly some missing Meprozine (demerol/phenergan).  Not suicidal, just hurting. I used to think toxicology was fascinating, and I had visions of exotic envenomations and higher biochemistry.  Nope.  This is community toxicology.  Ambien, Xanax, Valium, Lortab, Oxycontin.  Identify, observe, intubate if necessary, release when alert.  Fascinating.

Essential procedure:  I realized recently that residents in emergency medicine should add, to their procedure list, ‘get cup of ice for patient or family member.’  They’ll be doing it a lot more often than they intubate.

Nights are the time when young people, with otherwise uneventful, unemployed lives, realize that they aren’t tired enough to sleep and nothing is on television. And on Friday and Saturday, the drama-meter reaches an all-time high as young men and women scream at each other, fight like angry cats and declare their undying, drunken love.  Nights are when people who should be in bed wander the steamy summer nights, explore after-hours Wal-Mart, and invariably stop by the ER in hopes of some interesting story or medication.

They would be tired, and probably home in bed (instead of pushing their babies in strollers at all hours of the night) if they held gainful employment.  As Christine (of neuromotivator fame) observed:  ‘Get a job; it will make you tired every single time!’

1:55 am.  I’m up to 13 patients.  Among them, passing out and rash for 6-12 months.  As expected, a negative workup.  Thank heavens for the biscuits and jam our ward-clerk, Charlene, brought for us.  Biscuits and jam are as good as any anti-depressant on earth.

Before I came to work I watched Michael Caine in ‘Zulu,’ the movie about the British fighting the Zulu in 1879.  Surrounded and outnumbered, they won the day.  I feel surrounded and outnumbered.  But at least they could fire volleys with their .455 Martini-Henry rifles.  All I have is Lortab to throw at people.

02:45 am.  I have seen 17 folks.  Evaluated a baby for sepsis, diagnosed tennis elbow (an emergency if ever there was one) and have heard the nurses fielding question after question…’How long?’  ‘How many doctors are there?’  ‘Am I next?’

4:45 am.  Patient:  49-year-old male, wrecked vehicle after 45 minute police chase.  Charged with first offense failure to stop; second offense driving under suspension.  Under SC law, neither crime, nor their combination, constitute a felony.  His enlightenment?  ‘Doc, I messed up tonight!’  He’s lucky he wasn’t in Georgia.  They would have shot his tires out.  The SC legislature, and the DUI attorney lobby, robbed me of the joy of knowing he would go to prison.  Rats.

5:50  I’ve seen 25 patients.  I’m so tired I lie my head by the computer, but not before eating the last biscuit and jelly.  I…just…can’t…stop!  They keep coming.  The night, barring any other disasters, will involve 28 patient encounters.  Sutured chins, sick babies, motor vehicle accidents, chest pain, falls, lacerations, even some hypergloobiotrineziosis.  Well, it’s as good a name as any for all of the weak, dizzy, tingling all over, confused, rash covered chest pain patients I’ve seen.

8:00  I’m trying to finish up some charts.  Reflecting on how we continue to do this job despite the fact that modern emergency care is an almost impossible endevor, in which we are always overwhelmed and always at the mercy of someone with no real problem, no desire to pay their bill and no interest at all in how exhausted or beaten down the staff may be when they check in for six months of itching.

EMTALA has killed us, and we continue to do our best.

8:30:  I’m tired.  Finishing charts and going home.

God give us all patience and strength to do the right thing, and the courage to confront what is wrong.

Edwin