ER Uck

Things change.  As a teen, premed, and medical student I thought I would love the ER.  Drama.  Adrenaline.  Gore.  Rescue.  Codes.  Excitement.  The stories from my trauma surgery rotation were awesome.  Real doctors saving lives.

Well, I changed my tune the first month of residency.  A few weeks after my hood and M.D. degree began to gather dust I found myself in the UNMC ER.  I hated it.  I wasn't prepared to handle complicated traumas.  I wasn't confident enough to send people home.  I was anxious without a scheduled list of patients I knew, or the time to get to know them.  And I was never so glad to start back to back months of inpatient hospital rotations.  Despite loving to suture, not minding the blood and unpredictability of delivering a baby, and enjoying solving a complicated medical case once in a while, ER was clearly not what I was cut out to do.

After that month I've avoided the ER.  I had to do two more weeks when I started in Grand Island, and thankfully, that wasn't so bad.  I had a little more experience, a little more confidence, and a little more support from the staff.  Still, you didn't find me signing up for extra shifts, and you couldn't pay me enough to lose years off my life while moonlighting in some small town all by myself.

Well, my avoidance couldn't last forever.  This month I've been working in the small town of St. Paul to fulfill a requirement for residency.  (Ironic, isn't it, that I picked the shortest month of the year?)  Part of the job for most small town doctors, including mine for the month, is covering the ER.  No ER doctors.  No trauma surgeons.  No orthopedists.  No stroke team.  No cath lab.  Eek!  With 5 of 6 ER call nights in the books, I'm glad it's almost over.

Yesterday was my busiest ER day so far.  Sure, I'd had 3 or 4 patients at once before, but most of those patients could have been taken care of in the clinic.  Nothing "emergent."  Nothing broken, bleeding, dying, infarcting or seizing.  Yesterday, was different.  As I was waiting for labs to come back on a woman with abdominal pain, a guy came in screaming with leg pain after falling off of a roof.  (What he was doing on the roof during a blizzard is beyond me.)  As X-ray was taking his picture, I overheard the scanner report that a 40 year old was coming in with a probable tibia fracture after an accident.  Then, before the nurse could get up from the desk the phone rang with another ambulance calling in with a kid who hit a tree sledding.  This all after we had just cleaned up after the seizing, questionable stroke, vomiting, supratherapeutic and bleeding, vasculopathic, elderly patient.  Is it time to go home yet?

Actually, it all went fine.  I felt a sense of accomplishment, and probably some unhealthy pride, when it was all over.  Still, I am happy that my days of covering the ER forever are numbered - one to be exact.

Not a Hotel

It's always been a pet peeve of mine when patients are rude in the hospital.  I know they are sick, in pain, and scared so they get away with a lot from sensitive me, but there is definitely a limit.  And, definitely, it sometimes crosses a line.  Here is some free advice for those rare few who think the hospital is a Hilton.

 

1.  You will not get a full night of sleep.  IV pumps beep.  Nurses take vitals.  Delirious patients next door scream.  Doctors make rounds before the sun comes up.  Your cozy bed is at home.  Oh yeah, and you are sick.  Why is it so surprising to people when they can't sleep?

 

2.  Hospitals are not substitutes for your home, nurses for your children, or doctors for your spouse.  This is maybe my biggest soap box, and maybe the one people will argue with the most.  I am amazed by the number of times it is the family member who request that their loved one be hospitalized, and often it isn't because of the extent of their illness.  It's usually because Daughter Donna doesn't have any more PTO, or it's the middle of the night and Sister Suzy has to work in the morning, or Local Pharmacy doesn't deliver meds until afternoon so Dad can't get his morning meds at home.  I'm thankful to not be one of the millions trapped in the sandwich generation, so I wholly admit to a lack of sympathy.  (Although empathy I have.)  Still, it is rare that the slow fade of health, memory, and strength sneak up on people.  It takes awareness, honesty, and difficult planning to prepare for it.  Fun - no.  Worth it - yes!  Ailing parents, consider what your stubborn independence does to your children when you hurt yourself.  Spouses, protect, don't cover for your loved one.  Busy children, get your priorities in line.  And everyone, accept help when it's offered so you don't have to demand it when it's too late.

 

3.  Stop complaining about the food.  First of all, it isn't that bad.  Secondly, it's usually your doctor who tells the cafeteria not to bring you salty french fries, or pure sugar syrup, or a 3000 calorie hamburger because that is what we've been telling you to eat (or not eat) at home for years.

 

4.  Therapy is for your benefit, so don't refuse it for lame reasons.  That goes for physical therapy (which is what I see refused most often), but also for lab draws, replacing blown IV's, and going down to the radiology department to get a better quality X-ray when you know they could wheel the portable unit up to your bed.  "I'm too tired," is the reason we ordered it in the first place.  Getting better isn't comfortable.

 

5.  When it's time to go - Go!  Maybe this echos some of #2.  Still, when you're in the ER at 2AM and don't know what to do because you aren't prepared, I can consent to the admission.  But, after three days of fighting with "utilization review" and explaining medical necessity to your insurance company, you have to go.  That's plenty of time to meet with social work, arrange home health care, pick a nursing home, get Betty Jo to fly in from California, learn how to give injections, or make arrangements with your employer.  The truth is, once we've done all we can to help you, sitting in a hospital can actually harm you - the risk of infection exposure, medication errors, anemia from repetitive blood draws, radiation exposure from repetitive imaging, falls, and not to mention draining your (or the government's) bank account.  Please, just go.

 

Thank you to the 95% of agreeable, pleasant patients.  And to the rest of you, I still really do like you and want you to get better even when you frustrate the crap out of me.

Day Off

After a busy month in January, it is nice to start February with a little break.  My next rotation starts on Monday, so I intend to take this day O-F-F.  (I debated turning off my pager completely, but I have a needy OB patient who is due, and I'd feel bad to spring her on any of my covering staff if she comes in today... again... but for real this time.)

 

I started the day by sleeping in.  Out of bed at 6:20AM.  That's pretty late, huh?  But, considering for the past four weeks I've been at the hospital by then, it felt pretty refreshing.  And, with my next rotation in St. Paul, there won't be much sleeping in for the next few weeks either.  Also, being the morning person I am, it also gave me an hour to myself as the boys slept in, too.  Three out of five days of Bible study were done before the first bedroom door creaked open and bare feet pattered toward me sitting at the dining room table.

 

The goals for the day are intentionally few.  Breakfast.  Bible study.  Blog.  Run an errand to the bank, and Owen requested we go to the library which sounds good to me as I'm in need of another book on tape for my month of commuting.  Maybe a shower.  Maybe plan meals for next month.  And if I'm really bored maybe some cleaning or studying during nap time.

 

The things I won't be doing today include: clinic notes, t.v., Facebook, or this stupid "BubbleGame" I've been addicted to lately.  I'm not about to waste this perfect this day.

 

It's going to be a great day off!

 

(I was going to include a photo of the three of us with our bedheads this morning, but I can't find the SD card for the camera.  You'll have to use your imagination of what a little boy with long dark hair, another little boy with thin light hair, and me look like in the morning.  And, add "find SD card" on the goals for today.)