Running Rant II…the sequel

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

 

35 thoughts on “Running Rant II…the sequel

  1. I would like to change that a little. “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.”
    I was a welfare mother for a few years. Then I was employed with no insurance. I had two small babies. NIghts were when the fever invariably spiked. When I called ER – every single time the Triage nurse said to bring them in to be evaluated. Not once did they say- oh its just **** they will be fine. Night is when you are sitting there with a small child with a fever of 104 and no insurance , knowing the on the morrow there is no doctor that is going to your medi-cal or that will see with no insurance and when you are remembering all the news stories about the child that didnt get taken to the ER that died………….. I am sure in some instances you are perhaps correct. However, I was this welfare mother for a very short time. I worked, went to school, and became a USDA inspector and finally obtained the coveted medical insurance and was able to finally get my daughters tonsils out ( the ones that should have been taken out years ago that state medi-cal wouldnt pay for) and then those horrendous sudden fevers stopped and I didnt have those middle of the night ER visits.
    I am sure you are exhausted by trivial ER visits. However to many of the people coming in, they have no other options and perhaps to them it is not so trivial. If you have a 3 year old with 104 fever needing antibiotics and no other place to get them…………..? what else can you do?

  2. 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!

    This is because a fever is unimportant? It couldn’t possibly be caused by a middle ear infection, or strep throat? Neither of which the pediatrician would be able to assess effectively over the phone.

    I have not worked in an ER, but I have worked in specialist offices (GI, OB/GYN, family practice, and Cardio). I can almost guarentee that the patient’s mother either called the doc seeking a called in script for anti-biotics, or reported symptoms consistant with an ear and/or throat issues. Either senario would prompt a primary doc to send his/her patient to the ER for further assessment…especially if it is a very young child.

  3. Here is another “non-emergency” scenario for your consideration. My husband who worked everyday and did not hang out at wal-mart on saturday nights……… came home from work with back pain and went to urgent care ( also for emergencies). He was diagnosed with a back injury. A week later he was in an emergency room in more pain and was diagnosed with constipation. A few days later his Primary care physician put him the hospital and ran alot of tests and he was diagnosed with esophogeal cancer and it was found it had spread all thru-out his abdomen and into his liver. He died two months later. So was this an emergency? Was he wasting the doctors time?

  4. I am very, very thankful to ER doctors. People get sick outside of office hours, and that’s what the ER is for. I’ve been to the ER twice in my life and I’m very thankful for the medical teams who cared for me. (once, when I was 10 years old, I fell off my bike and my very-frightened father felt the need to rush me to the ER for stitches… though that probably wasn’t a true emergency. the other time, I was 17 and was in a really bad car wreck. that was as much of an emergency as you can get… unconscious, life support, the whole nine yards.) There are many things that can occur between “stitches” and “life support” that constitute true emergencies, and in those situations I’m thankful for ER docs.

    I know EMTALA is at least in theory a good thing, but for your sake, doc, I’m really sorry that you have to volley all these non-emergency emergencies.

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