Today, a running commentary on life in the ER.

It’s 7:19 am as I start my day-shift and begin to write. My partner is trying to wind up things for the night. In our medium sized, 20-bed department, we see around 37K patients each year. The entire county, where we are the only hospital, has about 65K humans. (Thank heavens we don’t see squirrels…we’d need a new department even worse!)

In other words, we see everyone in the county every two years. OK, not really. We see about 20% of the county ten or twenty times a year. Or somewhere in between.

7:30 am Ambulances x 5 have arrived here in the last 90 minutes. Sigh. So much for a quiet morning of peaceful reflection.

8:50 am Did someone unload the crazy train? Tegretol overdose ‘just to get high.’ Corneal abrasion has ‘seizure’ in parking lot after discharge. Chest pain patient is seeing green lasers, hates my guts (from a previous encounter, apparently less than amicable) and demands an echocardiogram because he knows his heart is ‘huge.’

A moment’s reflection: I love my job. But it can be taxing. And I’d honestly prefer to be at church with Jan and the kids. But then, Christianity doesn’t happen at church. Emergency medicine , medicine as a whole, in all it’s weirdness, is a real exercise in learning to love the unloveable, in relying on God for equanimity and insight, and in understanding the chaos that inhabits most human lives. But, and this might be my prayer some mornings: ‘Lord, I know you love the insane and troubled; but could you send me a couple of easy sore throats? Amen.’

10:15 am So, the psychotic patient gets a ‘tele-psych’ consult, since we have no psychiatrist. The television with the moving camera (like an eye) on top will be connected to the Internet in his room. He will speak to the psychiatrist through the television. The television will speak to him, in effect. What could be better for a schizophrenic, I ask you? Only if the psychiatrist on the other end were dressed as an alien…or angel.

A little shortness of breath…not me, my patient. Sweet, sincere, actually sick. She even had a sore throat. Thank you, Lord, for answering my prayer for just a little something easy!

Three in the waiting room, eight patients being seen by our PA and I. How much more chest pain lurks beyond the triage doors? Hard to say. It has certainly been the theme recently. All things, it seems, end in chest pain. Vomiting, headache, overdose, depression, ankle injury, infection…in the final analysis, each is united by the common theme of chest pain, heaviness, pressure, tightness, etc.

A reflection: Is our national medical obsession with chest pain a manifestation of our national anxiety and fear of uncertainty? Of our national terror of death, or our collective unease even in the face of relative security and prosperity? Is it because we’ve subsituted faith for pharmaceuticals?

12:58 Busier now; my partner is here and EMS has begun to arrive in earnest. Post church falls, work syncope, and assorted chest pains arrive as the day moves along. It’s your average Sunday, though with less chaos. I’ve seen a child with a broken tibia, a pneumonia and a bronchitis. A patient with congestive heart failure. I’ve eaten a chocolate chip cookie and a bag of jalapeno potato chips.

Who knows what the next three hours hold? I’m here until 4pm. An easy slide out the door? A bus wreck? Few things raise my heart-rate these days. It’s the nature of the practice, I suppose.

Another insight: I’m here today along with doctors and nurses, patients and ancillary staff. We are doing our jobs well; the system, though imperfect, purrs along effectively. Many of those who so want to overhaul and remake our broken system are home, reading the paper and having a quiet brunch. I wonder who understands it all best?

2:00 pm  The psyciatric consult is done; we’re committing our psychotic gentleman.  He has threatned me; it’s not the first time I’ve been threatened.  He has also, in his profound religious delusion, rebuked my friend and nurse Frank.  ‘I rebuke you!’  He said.  Frank agrees that a good ‘rebuking’ is healthy for the soul.  Frank feels better.  I was not rebuked, at least not directly.  I feel somehow diminished and less important.

2:30 pm  I have eaten a sausage, egg and cheese biscuit, two more cookies from Subway, ssorted tortilla chips with bean dip.  Bits of beef-stick.  Imbibed diet-Coke and sweet-tea.  In the ‘Habitrail’ that is the emergency department, unhealthy food is a kind of anti-depressant, or distraction.

3:00  More falls and contusions.  Pneumonia and dehydration in elderly lady.  Broken leg in small child.  Post-op bleeding in young woman; the day goes on.  At last, it’s time to leave.

3:30  A good day.  No one has died; I have only been threatened, not assaulted.  I have worked with a good staff.  I have, as far as I know, made no serious mistakes.   That is, at least, my prayer before work and after work.

Life in the ER.  No dull moments, the gift of caring for humans who bear the image of the Creator, lots of junk food and a near rebuking.

5:05 pm  Home at last.  Hugged by children, kissed by wife and going to dinner.  At the end of work, a brilliant light of ineffible joy.  Hopefully, at the end of life, the same; though brighter and without end.

God bless you this Lord’s day and every day from now until the end of all things!


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