I just finished a run of two shifts at Tiny Community Hospital.  Each was 24 hours in duration, separated by a 24 hour break.  As I have tried to explain to many of my colleagues, places like this are enjoyable.  First of all, the volume is low; I saw about 15 patients in each 24 hour period.  I worked, I napped and I capped last night off with about four relatively uninterrupted hours of sleep in a recliner.  Considering I get paid for every hour I’m there, it’s not a bad deal!  (And wonder of wonders, the facility uses dictation for the physician record!)

Although the patients are typically not very complex, there are times. Trauma victims still arrive due to the distance from referral centers. Patients with concerning chest pain still come to see me. I have cardioverted and incised and splinted and all the rest.  Yesterday, I even performed one of my favorite procedures:  I used the EZ-IO drill to put an intraosseus line into the humerus of a very sick patient.  (When it’s you and one nurse, there isn’t a lot of time to mess around.)

But perhaps the most remarkable thing about my last two shifts was this:  in 48 hours of patient encounters, I wrote not a single prescription for a narcotic, nor was I asked for one.   That may be a record.

So do not despair, fellow traveler.  There are good days and bad days in emergency medicine.  But wonders and miracles still occur.


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